MEDICARE: BILL STAHLBERG 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	363AS0400X	Surgical Physician Assistant	PA01128	OR
2	363AS0400X	Surgical Physician Assistant	PA-6052	ID
3	363AS0400X	Surgical Physician Assistant	PA61078913	WA

General Provider Information

NPI Number	:	1992743215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILL STAHLBERG PA-C

Provider Business Mailing Address
First Line	:	1400 E KINCAID ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 FREEWAY DR
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-5445
Country	:	US
Telephone Number	:	360-814-6800
Fax Number	:	360-814-6953

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/24/2022

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Directions to “ BILL STAHLBERG PA-C” Practice Location

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