Basic Information
Provider Information
NPI: 1750458329
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARNDT
FirstName: MARY ANN
MiddleName: K
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 421
Address2:  
City: LIBERTY LAKE
State: WA
PostalCode: 990190421
CountryCode: US
TelephoneNumber: 8667472455
FaxNumber:  
Practice Location
Address1: 105 W 8TH AVE
Address2: SUITE 7060
City: SPOKANE
State: WA
PostalCode: 992042302
CountryCode: US
TelephoneNumber: 5093400930
FaxNumber: 5097472054
Other Information
ProviderEnumerationDate: 11/29/2006
LastUpdateDate: 09/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300XMD157887ORN Allopathic & Osteopathic PhysiciansInternal MedicineNephrology
207RN0300XMD30286879WAY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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