Provider Demographics
NPI:1275708240
Name:FOUTZ, MARY SLOAN (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SLOAN
Last Name:FOUTZ
Suffix:
Gender:F
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:101 W 8TH AVE STE 1400
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-2200
Practice Address - Fax:509-224-7070
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60004087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
7628FOOtherASURIS NW HEALTH
91100762799202A043OtherTRIWEST
WA9657222Medicaid
ID808048700Medicaid
9162159OtherAETNA
WA0236544OtherLABOR & INDUSTRIES
WA9657222Medicaid