Basic Information
| Provider Information | |||||||||
| NPI: | 1003144825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STROUD | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | ROBYN ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | LMP. | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | MA60117881 | WA | N | Other Service Providers | Community Health Worker | 174400000X | MA60117881 | WA | Y | Other Service Providers | Specialist |
No ID Information.