| Doctor Name: | MRS. TRACI STOUT |
| NPI Number: | 1265849566 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN BSN |
| License Number: | RN60061565 |
| Business Practice Address: | 171 Wishpoosh Rd Toppenish, WA - 98948 |
| Business Phone Number: | 5098657965 |
| Business Fax Number: | 5098652195 |
| Mailing Address: | 171 Wishpoosh Rd, TOPPENISH |
| State: | WA |
| Postal Code: | 98948 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/18/2014 |
| NPI Last Update Date: | 07/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WH0200X |
| License Number: | RN60061565 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Home Health |
| Taxonomy Definition: | |