Healthcare Provider Details

I. General information

NPI: 1285160754
Provider Name (Legal Business Name): JEANNIE MOORE STUBBLEFIELD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UW LABORATORY MEDICINE NW120 1959 PACIFIC STREET, BOX 357110
SEATTLE WA
98195-7110
US

IV. Provider business mailing address

UW LABORATORY MEDICINE NW120 1959 PACIFIC STREET, BOX 357110
SEATTLE WA
98195-7110
US

V. Phone/Fax

Practice location:
  • Phone: 615-579-3042
  • Fax:
Mailing address:
  • Phone: 615-579-3042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: