Provider Demographics
NPI:1477957884
Name:WEAR, STEPHANIE (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WEAR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8862 BENDER RD
Mailing Address - Street 2:SUIT 101
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-8800
Mailing Address - Country:US
Mailing Address - Phone:360-354-1115
Mailing Address - Fax:360-354-0321
Practice Address - Street 1:8862 BENDER RD
Practice Address - Street 2:SUIT 101
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-8800
Practice Address - Country:US
Practice Address - Phone:360-354-1115
Practice Address - Fax:360-354-0321
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60450749174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist