Healthcare Provider Details

I. General information

NPI: 1912234659
Provider Name (Legal Business Name): FAIRUZA MAGSUM STEVENSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FAIA MAGSUM STEVENSON NP

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E MILL PLAIN BLVD
VANCOUVER WA
98663
US

IV. Provider business mailing address

14204 NE SALMON CREEK AVE
VANCOUVER WA
98686-9600
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-4040
  • Fax:
Mailing address:
  • Phone: 360-882-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP.AP.30008028-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: