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General NPI Number Information
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NPI Number | 1255800272
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Entity Type | Individual
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Provider Name | STEPHANIE LAUREN PEARSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 825 EASTLAKE AVE E
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City | SEATTLE
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State | WA
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Zip | 98109-4405
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Country | US
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Telephone | 855-557-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 2652 W WINNEMAC AVE APT B
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City | CHICAGO
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State | IL
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Zip | 60625-2712
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Country | US
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Telephone | 847-715-6788
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | WA
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