Healthcare Provider Details

I. General information

NPI: 1629654520
Provider Name (Legal Business Name): CHRISTINE STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 LILLY RD NE STE 210
OLYMPIA WA
98506-5101
US

IV. Provider business mailing address

525 LILLY RD NE STE 210
OLYMPIA WA
98506-5101
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8550
  • Fax: 360-413-8827
Mailing address:
  • Phone: 360-413-8550
  • Fax: 360-413-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberMD61689477
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD61689477
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: