Provider Demographics
NPI:1083106645
Name:WIMS, STEPHANY DAWN (ARNP)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:DAWN
Last Name:WIMS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:STEPHANY
Other - Middle Name:DAWN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3124 S 19TH ST STE 240
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2433
Mailing Address - Country:US
Mailing Address - Phone:253-792-6111
Mailing Address - Fax:
Practice Address - Street 1:3124 S 19TH ST STE 240
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2433
Practice Address - Country:US
Practice Address - Phone:253-792-6111
Practice Address - Fax:253-459-6110
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60859793363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner