1013951342 NPI number — ELLEN K STEHOUWER DO

Table of content: ELLEN K STEHOUWER DO (NPI 1013951342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013951342 NPI number — ELLEN K STEHOUWER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEHOUWER
Provider First Name:
ELLEN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013951342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
463 TREMONT ST W
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98366-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-876-2434
Provider Business Mailing Address Fax Number:
360-876-2696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20730 BOND RD NE STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-626-1166
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2006

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: 207Q00000X , with the licence number:  OP00001873 , 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: 8359390 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7817436 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8931448 . This is a "CRIME VICTIMS COMP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00029282 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 171376 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com