Provider Demographics
NPI:1700829843
Name:SOLIDAY, STACIA J (ARNP)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:J
Last Name:SOLIDAY
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 1:100 3RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9730
Mailing Address - Country:US
Mailing Address - Phone:509-725-7501
Mailing Address - Fax:509-725-7504
Practice Address - Street 1:214 SW MAIN
Practice Address - Street 2:
Practice Address - City:WILBUR
Practice Address - State:WA
Practice Address - Zip Code:99122-0582
Practice Address - Country:US
Practice Address - Phone:509-647-5321
Practice Address - Fax:509-647-2238
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00132618163W00000X
WAAP30006947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA193676OtherDEPT. OF L & I
WA7101132Medicaid
WA9644220Medicaid
WACJ6525OtherMEDICARE RAILROAD
WA7117450Medicaid
WA7117450Medicaid
WAG8852064Medicare PIN
WA9644220Medicaid
WA7101132Medicaid
WA508530Medicare Oscar/Certification
WA508529Medicare Oscar/Certification