1225027436 NPI number — STEPHANIE ROSE MOLINE M.D.

Table of content: SHANNON BRACCO (NPI 1023639481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225027436 NPI number — STEPHANIE ROSE MOLINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLINE
Provider First Name:
STEPHANIE
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERRY
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225027436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99220-3868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-228-1000
Provider Business Mailing Address Fax Number:
509-252-9300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 W IRONWOOD DR STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-625-4700
Provider Business Practice Location Address Fax Number:
208-625-4701
Provider Enumeration Date:
10/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X , with the licence number:  7761579 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: MD00041718 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 910000395 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8322315 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0164026 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7744005 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 806453700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7631MO . This is a "ASURIS NW HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000010140846 . This is a "BLUE SHIELD OF IDAHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: KS665 . This is a "BLUE CROSS OF IDAHO" identifier . This identifiers is of the category "OTHER".




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