Provider Demographics
NPI:1447581830
Name:BLOWERS, STACY RAE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:RAE
Last Name:BLOWERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-3465
Mailing Address - Country:US
Mailing Address - Phone:509-607-2456
Mailing Address - Fax:
Practice Address - Street 1:2612 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-5138
Practice Address - Country:US
Practice Address - Phone:509-607-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist