ERIC DUDENHOFER ARNP PS (NPI# 1245767631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245767631 |
| Entity Type | Organization |
| Organization Name | ERIC DUDENHOFER ARNP PS |
| Other Organization Name | MID RIVER SKIN CLINIC |
| Practice Address |
1271 Highland Ave # B Clarkston WA 99403-2846 |
| Mailing Address |
Po Box 193 Nine Mile Falls WA 99026-0193 |
| Practice Telephone | 5093214590 |
| Mailing Telephone | 5093214590 |
| Mailing Fax Number | 5093214593 |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2019-06-09 |
| Authorized Official Name | ERIC DUDENHOFER (PRESIDENT/CEO) |
| Authorized Official Telephone | 5093214590 |
| Authorized Official Credential | ARNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Mid River Skin Clinic | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 12727 W 14th Ave, Airway Heights, WA 990019409 | 5093214590 | |
| 101 W Cascade Way Ste 100, Spokane, WA 992086000 | 5093214590 | |
| 6831 State Highway 291, Tumtum, WA 990349715 | 5093214590 |
| Street Address |
1271 HIGHLAND AVE # B |
| City | CLARKSTON |
| State | WA |
| Zip Code | 99403-2846 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306409669 | Jessica Elaine Krull | Specialist/Technologist | 807 3rd Street, Clarkston, WA 99403 | 2019-04-22 |
| 1477006526 | Idaho County Rideshare | Non-emergency Medical Transport (VAN) | 1470 Elm Street, Clarkston, WA 99403 | 2016-07-25 |
| 1679921340 | Jonathan Preszler | Counselor | 629 6th Street, Educational and Psychological Services, Clarkston, WA 99403 | 2016-06-02 |
| 1104204957 | Optimal Health and Wellness | Clinic/Center | 1267 Belmont Way, Clarkston, WA 99403 | 2015-05-13 |
| 1326456351 | David Nygren | Pharmacist | 506 5th St, Clarkston, WA 99403 | 2014-07-22 |
| 1255672895 | Alpowa Healthcare, Inc. | Hospice Care, Community Based | 1370 Bridge Street, Clarkston, WA 99403 | 2013-03-06 |
| 1265799407 | Elizabeth Bagnulo Dacey | Pathology | 1225 Highland Avenue, Clarkston, WA 99403 | 2012-04-12 |
| 1649586256 | Zeeshan Afzal | Internal Medicine | 1119 Highland Ave Ste 3, Clarkston, WA 99403 | 2010-08-20 |
| 1154657955 | Twin River Vision, Inc. | Optometrist | 306 5th Street, Clarkston, WA 99403 | 2009-10-29 |
| 1649429317 | Elizabeth Marie Allen-racicot | Specialist | 1013 Bridge Street, Clarkston, WA 99403 | 2008-09-17 |
| Find all providers in zip 99403 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033767223 | William Bodnar | Nurse Practitioner | 3701 College Ave, Clarkston, GA 30021-2508 | 2019-08-30 |
| 1619537636 | Samina A. Damani | Nurse Practitioner | 3700 Market St Ste E, Clarkston, GA 30021-2600 | 2019-06-20 |
| 1457911281 | Megan Clemence | Nurse Practitioner | 7210 N Main St Ste 200, Clarkston, MI 48346-1575 | 2019-06-14 |
| 1821577479 | Jerrica Kallio | Nurse Practitioner | 909 Verdi Way, Clarkston, GA 30021-1057 | 2018-08-13 |
| 1346731866 | Wanda M Lewis | Nurse Practitioner | 10112 Windy Knoll Ct, Clarkston, MI 48348-2182 | 2018-05-21 |
| 1104334846 | Tiffany Johnson | Nurse Practitioner | 1040 Noble Vines Dr Apt 2, Clarkston, GA 30021-1345 | 2018-01-16 |
| 1720596802 | Kenzie Gardner | Nurse Practitioner | 7643 Olde Sturbridge Trl, Clarkston, MI 48348-4613 | 2018-01-11 |
| 1710343181 | Teri Massey | Nurse Practitioner | 518 Sunrise Dr, Clarkston, MI 48348-1493 | 2016-01-14 |
| 1275998833 | Joyce John | Nurse Practitioner | 4378 Bluff Pointe, Clarkston, MI 48348-5081 | 2015-12-28 |
| 1235259748 | Charmaine R Allen-johnson | Nurse Practitioner | 619 Diagonal St, Clarkston, WA 99403-2041 | 2007-03-29 |
| Find all providers in CLARKSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.