Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP60489248 | WA |
N | 363LA2100X | Nurse Practitioner - Acute Care | 201401374NP-PP | OR |
N | 363LA2100X | Nurse Practitioner - Acute Care | 53-76253-092 | KS |
N | 363LA2100X | Nurse Practitioner - Acute Care | AP 60489248 | WA |
NPI | 1013325968 |
---|---|
Provider Name | Mrs. Stacey Ann Deschamps |
First Address | Richland, WA 99352-9532 |
Second Address | Kennewick, WA 99336-7825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2014 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013325968 | (05) | WA |