| NPI | 1245767631 |
|---|---|
| Doing Business As | MID RIVER SKIN CLINIC |
| Entity Type | Organization |
| Authorized Contact | ERIC DUDENHOFER President/CEO 509-321-4590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2019-06-09 |