Provider Demographics
NPI:1619108438
Name:SHOEMAKER, STEPHANIE A (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3761
Mailing Address - Country:US
Mailing Address - Phone:509-575-8000
Mailing Address - Fax:
Practice Address - Street 1:4003 CREEKSIDE LOOP
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3962
Practice Address - Country:US
Practice Address - Phone:509-248-3263
Practice Address - Fax:509-225-2705
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60193374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215062502Medicaid
TX215062501Medicaid
TX215062503Medicaid
TX215062501Medicaid
TXTXB107505Medicare PIN
TXTXB107517Medicare PIN