Provider Demographics
NPI:1649081035
Name:QUEZADA DUBOIS, STACY LYNN (NP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:QUEZADA DUBOIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24104 S HORSE HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-5103
Mailing Address - Country:US
Mailing Address - Phone:970-978-5329
Mailing Address - Fax:
Practice Address - Street 1:12406 E DESMET AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2996
Practice Address - Country:US
Practice Address - Phone:509-688-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61452970363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner