MEDICARE: STEPHANIE REIERSON

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	390200000X	Student in an Organized Health Care Education/Training Program		WA

General Provider Information

NPI Number	:	1932657111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE REIERSON

Provider Business Mailing Address
First Line	:	8040 MARY AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-4238
Country	:	US
Telephone Number	:	360-441-2645
Fax Number	:

Provider Business Practice Location Address
First Line	:	8040 MARY AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-4238
Country	:	US
Telephone Number	:	360-441-2645
Fax Number	:

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

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	09/15/2016

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