1235746785 NPI number — MRS. STEPHANIE MARIE SAWYER HIS

Table of content: MRS. STEPHANIE MARIE SAWYER HIS (NPI 1235746785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235746785 NPI number — MRS. STEPHANIE MARIE SAWYER HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAWYER
Provider First Name:
STEPHANIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
HIS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAWORTH
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
HIS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235746785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4160 6TH AVE SE STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98503-1039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-456-4756
Provider Business Mailing Address Fax Number:
360-960-8315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
512 W YELM AVE UNIT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YELM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98597-8773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-960-8316
Provider Business Practice Location Address Fax Number:
360-960-8315
Provider Enumeration Date:
09/29/2020

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: 237700000X , with the licence number:  60667209 , 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)





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