Healthcare Provider Details

I. General information

NPI: 1962065722
Provider Name (Legal Business Name): STEPHANIE A CAMERON RN, CCM, CAPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9813 S 231ST ST
KENT WA
98031-3144
US

IV. Provider business mailing address

9813 S 231ST ST
KENT WA
98031-3144
US

V. Phone/Fax

Practice location:
  • Phone: 206-293-3078
  • Fax: 206-260-2877
Mailing address:
  • Phone: 206-293-3078
  • Fax: 206-260-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN603352240
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: