Healthcare Provider Details

I. General information

NPI: 1841476223
Provider Name (Legal Business Name): STACIE E. MAURER MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 116TH AVE NE SUITE NUMBER 206
BELLEVUE WA
98004
US

IV. Provider business mailing address

PO BOX 50150
BELLEVUE WA
98015-0150
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-0199
  • Fax: 425-462-1742
Mailing address:
  • Phone: 425-228-5228
  • Fax: 425-228-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD30354
License Number StateWA

VIII. Authorized Official

Name: DR. STACIE ELIZABETH MAURER
Title or Position: OWNER
Credential: MD
Phone: 425-454-0199