MEDICARE: STACEE ANDERSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA703	NV
2	363A00000X	Physician Assistant	PA10005154	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467438762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEE ANDERSON PA-C

Provider Business Mailing Address
First Line	:	PO BOX 421
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0421
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 E CENTRAL AVE
Second Line	:	SUITE 440
City	:	SPOKANE
State	:	WA
Zip	:	99208-6291
Country	:	US
Telephone Number	:	509-489-2600
Fax Number	:	509-789-9064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	04/05/2021

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Directions to “ STACEE ANDERSON PA-C” Practice Location

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