Healthcare Provider Details

I. General information

NPI: 1699684571
Provider Name (Legal Business Name): BIOSANTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 ENSIGN RD NE
OLYMPIA WA
98506-5074
US

IV. Provider business mailing address

17404 E SANTA ROSA LN
FOUNTAIN HILLS AZ
85268-3006
US

V. Phone/Fax

Practice location:
  • Phone: 909-708-9768
  • Fax: 360-634-8234
Mailing address:
  • Phone: 360-785-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE PAIGE WHITWORTH
Title or Position: PHYSICIAN ASSISTANT
Credential: PA
Phone: 909-708-9768