Healthcare Provider Details

I. General information

NPI: 1942637251
Provider Name (Legal Business Name): STEPHANIE L ESBENSHADE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE RENEE LEDOUX

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4250
US

IV. Provider business mailing address

314 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4250
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-7140
  • Fax:
Mailing address:
  • Phone: 253-403-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60403586
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60403586
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60403586
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP60403586
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: