Provider Demographics
NPI:1639727704
Name:INGLE, STACY LEIGH (CNM)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LEIGH
Last Name:INGLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34709 9TH AVE S STE B500
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6789
Mailing Address - Country:US
Mailing Address - Phone:253-944-6950
Mailing Address - Fax:
Practice Address - Street 1:34709 9TH AVE S STE B500
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6789
Practice Address - Country:US
Practice Address - Phone:253-944-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60977657367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2143568Medicaid