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General NPI Number Information
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NPI Number | 1457032005
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Entity Type | Individual
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Provider Name | JONATHAN STACKHOUSE ARNP
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Gender | Male
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 4800 SAND POINT WAY NE OC.9.830
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City | SEATTLE
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State | WA
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Zip | 98105-3901
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Country | US
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Telephone | 206-987-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 SAND POINT WAY NE OC.9.830
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City | SEATTLE
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State | WA
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Zip | 98105-3901
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Country | US
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Telephone | 206-987-0000
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP61550697
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License Number State | WA
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