Healthcare Provider Details

I. General information

NPI: 1174916449
Provider Name (Legal Business Name): STEPHANY HASSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 7TH AVE FLOOR 3
SEATTLE WA
98104-1132
US

IV. Provider business mailing address

1082 FAIRVIEW AVE APARTMENT R3
BOWLING GREEN OH
43402-1257
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-4541
  • Fax:
Mailing address:
  • Phone: 567-686-7930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0006220
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60539314
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: