Healthcare Provider Details

I. General information

NPI: 1821457086
Provider Name (Legal Business Name): STEPHANIE LARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ROSEN MD

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 POINT FOSDICK DR # 250
GIG HARBOR WA
98335-1700
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-530-8000
  • Fax: 253-530-8081
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNE30202
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.MD.70112897
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: