Provider Demographics
NPI:1235592015
Name:SHUMWAY, KODI ALICIA-THERESA (NA)
Entity Type:Individual
Prefix:MRS
First Name:KODI
Middle Name:ALICIA-THERESA
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:NA
Other - Prefix:MS
Other - First Name:KODI
Other - Middle Name:ALICIA-THERESA
Other - Last Name:RUTLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA
Mailing Address - Street 1:3754 W INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4736
Mailing Address - Country:US
Mailing Address - Phone:509-328-7041
Mailing Address - Fax:509-328-7582
Practice Address - Street 1:3754 W INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4736
Practice Address - Country:US
Practice Address - Phone:509-328-7041
Practice Address - Fax:509-328-7582
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide