Individual
DAVE STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
394.3 HIGHWAY 160, KAYENTA, AZ 86033
(928) 697-4100
Mailing address
PO BOX 3656, KAYENTA, AZ 86033-3656
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
1623113
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1623113
REGISTERED NURSE
—
Enumeration date
01/25/2018
Last updated
01/25/2018
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