Healthcare Provider Details

I. General information

NPI: 1619108438
Provider Name (Legal Business Name): STEPHANIE A SHOEMAKER RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 CREEKSIDE LOOP
YAKIMA WA
98908-3962
US

IV. Provider business mailing address

2811 TIETON DR
YAKIMA WA
98902-3761
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-3263
  • Fax: 509-225-2705
Mailing address:
  • Phone: 509-575-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP 60193374
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: