NPIMap

Organization Active NPI

Inclusa Health and Wellness PLLC

  • Obesity Medicine (Obstetrics & Gynecology) Physician
  • Liberty Lake, WA
National Provider Identifier
1891464905
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Obstetrics & Gynecology) PhysicianTaxonomy code 207VB0002X
Legal business name
INCLUSA HEALTH AND WELLNESS PLLC
Practice address
23403 E Mission Ave Ste 231
Liberty Lake, WA 99019-5087
Phone
(509) 367-4209
NPI assigned
Sep 10, 2021
Last updated
Jul 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stephanie Persondek, DONPI 1518288745
Title
Member
Phone
(208) 755-6731

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Obstetrics & Gynecology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VB0002X Primary

Addresses

Primary practice location

23403 E Mission Ave Ste 231
Liberty Lake, WA 99019-5087

Mailing address

21600 E Meriwether LN
Liberty Lake, WA 99019-7629
Phone (208) 755-6731

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220103000404 WA Part B Supplier - Clinic/Group Practice 9436540366 Receives reassigned benefits from 9 practitioners
Practice locations: Liberty Lake, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752710400000",
    "number": "1891464905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21600 E MERIWETHER LN",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197629",
            "telephone_number": "208-755-6731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23403 E MISSION AVE STE 231",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990195087",
            "telephone_number": "509-367-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INCLUSA HEALTH AND WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-10",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A",
        "authorized_official_last_name": "PERSONDEK",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "208-755-6731",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207VB0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.