Provider Demographics
NPI:1073206991
Name:STACHOFSKY, JILLIAN ASHLEY (RN)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ASHLEY
Last Name:STACHOFSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-8389
Mailing Address - Country:US
Mailing Address - Phone:509-528-3173
Mailing Address - Fax:
Practice Address - Street 1:5901 COLLINS RD
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-8389
Practice Address - Country:US
Practice Address - Phone:509-528-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60913110163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health