Provider Demographics
NPI:1518402312
Name:NEWMAN, STEPHANIE (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:NEWMAN
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 1:6506 WOLLOCHET DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8319
Mailing Address - Country:US
Mailing Address - Phone:253-853-3353
Mailing Address - Fax:
Practice Address - Street 1:6506 WOLLOCHET DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8319
Practice Address - Country:US
Practice Address - Phone:253-853-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018029174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist