Healthcare Provider Details

I. General information

NPI: 1033022108
Provider Name (Legal Business Name): STEPHANIE OMMANNEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NE 10TH AVE
OAK HARBOR WA
98277-5903
US

IV. Provider business mailing address

7440 W MARGINAL WAY S
SEATTLE WA
98108-4141
US

V. Phone/Fax

Practice location:
  • Phone: 360-499-7011
  • Fax:
Mailing address:
  • Phone: 360-499-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60764676
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: