Healthcare Provider Details

I. General information

NPI: 1295987329
Provider Name (Legal Business Name): STEPHANIE PAIGE WHITWORTH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 ENSIGN RD NE STE F
OLYMPIA WA
98506-5114
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 360-634-8949
  • Fax: 360-634-8234
Mailing address:
  • Phone: 909-708-9768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60188805
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: