Healthcare Provider Details

I. General information

NPI: 1023550373
Provider Name (Legal Business Name): STEPHANIE CAROLINE OUELLET RN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 8TH AVE NE STE 200
ISSAQUAH WA
98029-5436
US

IV. Provider business mailing address

510 8TH AVE NE STE 320
ISSAQUAH WA
98029-5436
US

V. Phone/Fax

Practice location:
  • Phone: 425-392-3030
  • Fax: 425-392-2564
Mailing address:
  • Phone: 425-507-0733
  • Fax: 425-283-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP60782634
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60782634
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: