Provider Demographics
NPI:1386181360
Name:MEDEARIS, STEPHANIE ANNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANNE
Last Name:MEDEARIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2207
Mailing Address - Country:US
Mailing Address - Phone:206-461-6923
Mailing Address - Fax:
Practice Address - Street 1:2119 2ND AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2207
Practice Address - Country:US
Practice Address - Phone:206-461-6923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP 00054146164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse