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General NPI Number Information
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NPI Number | 1063249308
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Entity Type | Individual
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Provider Name | STEPHANIE EDMONDS
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Gender | Female
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 08/02/2025
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Provider Practice Location Address
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Address Line | 2415 NE 134TH ST STE 301
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City | VANCOUVER
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State | WA
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Zip | 98686-3029
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Country | US
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Telephone | 360-882-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 2204 PACIFIC AVE N
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City | LONG BEACH
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State | WA
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Zip | 98631-3300
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Country | US
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Telephone | 360-642-3787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN60258435
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP70023788
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License Number State | WA
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