Provider Demographics
NPI:1003103565
Name:CAMERON, STEFANY JENEIFER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEFANY
Middle Name:JENEIFER
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21301 STATE ROUTE 410 E # 157
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8468
Mailing Address - Country:US
Mailing Address - Phone:253-737-5764
Mailing Address - Fax:253-220-2127
Practice Address - Street 1:21709 113TH ST E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7844
Practice Address - Country:US
Practice Address - Phone:253-737-5764
Practice Address - Fax:253-220-2127
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054996363A00000X
WAPA60511375363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical