Healthcare Provider Details

I. General information

NPI: 1831767425
Provider Name (Legal Business Name): REBECCA T STEVENSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA C TUFFLI

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

907 16TH AVE
SEATTLE WA
98122-4529
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2000
  • Fax:
Mailing address:
  • Phone: 415-686-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.61219702
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: