Healthcare Provider Details

I. General information

NPI: 1750329777
Provider Name (Legal Business Name): STEPHANI J. AMSTADTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 - 100TH ST. SW #31
LAKEWOOD WA
98499-2751
US

IV. Provider business mailing address

1600 116TH AVE NE STE 102
BELLEVUE WA
98004-3055
US

V. Phone/Fax

Practice location:
  • Phone: 253-584-3023
  • Fax: 253-582-1222
Mailing address:
  • Phone: 253-584-3023
  • Fax: 253-582-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number241321-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60031114
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: