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General NPI Number Information
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NPI Number | 1902512445
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Entity Type | Individual
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Provider Name | KRISTEN NICOLE STEPHENSON
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Gender | Female
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 19701 NE 399TH ST
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City | AMBOY
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State | WA
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Zip | 98601-3236
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Country | US
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Telephone | 360-247-5857
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Fax |
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Provider Business Mailing Address
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Address Line | 27510 NE ROTSCHY MILL RD
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City | YACOLT
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State | WA
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Zip | 98675-5307
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Country | US
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Telephone | 360-980-2149
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 61016815
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License Number State | WA
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