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General NPI Number Information
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NPI Number | 1669571394
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Entity Type | Individual
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Provider Name | BRENDA LEE ANITA MARIE STAVISH BSN MSN ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 16233 SYLVESTER RD SW SUITE G40
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City | BURIEN
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State | WA
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Zip | 98166-3045
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Country | US
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Telephone | 206-244-6625
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Fax | 206-244-6726
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Provider Business Mailing Address
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Address Line | 2916 N 32ND ST
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City | TACOMA
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State | WA
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Zip | 98407-6436
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Country | US
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Telephone | 206-890-8074
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Fax | 206-244-6726
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP30007442
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License Number State | WA
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