Basic Information
Provider Information
NPI: 1003144825
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STROUD
FirstName: AMY
MiddleName: ROBYN ELIZABETH
NamePrefix: MS.
NameSuffix: I
Credential: LMP.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1601 N WENATCHEE AVE
Address2:  
City: WENATCHEE
State: WA
PostalCode: 988011158
CountryCode: US
TelephoneNumber: 5096672720
FaxNumber:  
Practice Location
Address1: 1601 N WENATCHEE AVE
Address2:  
City: WENATCHEE
State: WA
PostalCode: 988011158
CountryCode: US
TelephoneNumber: 5096672720
FaxNumber: 5096635073
Other Information
ProviderEnumerationDate: 12/07/2009
LastUpdateDate: 12/07/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XMA60117881WAY Other Service ProvidersSpecialist 
172V00000XMA60117881WAN Other Service ProvidersCommunity Health Worker 

No ID Information.


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