Provider Demographics
NPI:1245767631
Name:ERIC DUDENHOFER ARNP PS
Entity Type:Organization
Organization Name:ERIC DUDENHOFER ARNP PS
Other - Org Name:MID RIVER SKIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDENHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-321-4590
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-0193
Mailing Address - Country:US
Mailing Address - Phone:509-321-4590
Mailing Address - Fax:509-321-4593
Practice Address - Street 1:1271 HIGHLAND AVE # B
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2846
Practice Address - Country:US
Practice Address - Phone:509-321-4590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty