Healthcare Provider Details

I. General information

NPI: 1124003413
Provider Name (Legal Business Name): STACIE LINNE KRABILL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST
TACOMA WA
98405-4933
US

IV. Provider business mailing address

1717 S J ST
TACOMA WA
98405-4933
US

V. Phone/Fax

Practice location:
  • Phone: 253-534-7000
  • Fax: 253-985-6812
Mailing address:
  • Phone: 253-534-7000
  • Fax: 253-985-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30007069
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: