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General NPI Number Information
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NPI Number | 1295299113
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Entity Type | Individual
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Provider Name | STEPHANIE JEAN HEMENWAY L.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 209 W MAIN AVE.
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City | MORTON
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State | WA
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Zip | 98356
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Country | US
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Telephone | 360-496-6196
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Fax | 360-496-5457
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Provider Business Mailing Address
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Address Line | PO BOX 22
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City | MORTON
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State | WA
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Zip | 98356
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Country | US
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Telephone | 360-496-6196
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Fax | 360-496-5468
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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 | 122400000X
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Taxonomy Name | Denturist
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License Number | DN60153160
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License Number State | WA
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