Healthcare Provider Details

I. General information

NPI: 1356779821
Provider Name (Legal Business Name): SHELLIE L. STOCKFISH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 34TH AVE SW
SEATTLE WA
98126-4208
US

IV. Provider business mailing address

1200 12TH AVE S STE 901
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-3164
  • Fax: 206-548-3165
Mailing address:
  • Phone: 206-548-3114
  • Fax: 206-762-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP60403592
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: