Provider Demographics
NPI:1114088457
Name:DUDENHOFER, ERIC P (ARNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:DUDENHOFER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6831 HWY 291
Mailing Address - Street 2:
Mailing Address - City:TUMTUM
Mailing Address - State:WA
Mailing Address - Zip Code:99034
Mailing Address - Country:US
Mailing Address - Phone:509-456-8444
Mailing Address - Fax:509-455-9227
Practice Address - Street 1:820 S MCCLELLAN ST
Practice Address - Street 2:SUITE 426
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2446
Practice Address - Country:US
Practice Address - Phone:509-456-8444
Practice Address - Fax:509-455-9227
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005374364SE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB34173Medicare ID - Type Unspecified