Healthcare Provider Details

I. General information

NPI: 1497715882
Provider Name (Legal Business Name): STEPHANIE G WESZTERGOM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 LEWIS RIVER RD STE D
WOODLAND WA
98674-9203
US

IV. Provider business mailing address

1057 12TH AVE
LONGVIEW WA
98632-2509
US

V. Phone/Fax

Practice location:
  • Phone: 360-225-4310
  • Fax: 360-225-4309
Mailing address:
  • Phone: 360-636-3892
  • Fax: 360-414-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30007922
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: