Provider Demographics
NPI:1518288745
Name:PERSONDEK, STEPHANIE MORBECK (DO)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MORBECK
Last Name:PERSONDEK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:MORBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23403 E MISSION AVE STE 231
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5087
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23403 E MISSION AVE STE 231
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5087
Practice Address - Country:US
Practice Address - Phone:509-367-4209
Practice Address - Fax:509-492-5624
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2024-05-17
Deactivation Date:2022-12-08
Deactivation Code:
Reactivation Date:2022-12-30
Provider Licenses
StateLicense IDTaxonomies
NVDO2372207V00000X
WAOP60541488207VB0002X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1518288745Medicaid