Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP61006352 | WA |
NPI | 1205477361 |
---|---|
Provider Name | Stephanie Sanderson |
First Address | Everett, WA 98204-2715 |
Second Address | Everett, WA 98204-2715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2019 |
Last Update Date | 30/09/2019 |