Provider Demographics
NPI:1679031470
Name:BEAUSHAW, STEPHANIE RUTH (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RUTH
Last Name:BEAUSHAW
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16126 POLLACK DR NW
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-9009
Mailing Address - Country:US
Mailing Address - Phone:253-778-5989
Mailing Address - Fax:
Practice Address - Street 1:16126 POLLACK DR NW
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-9009
Practice Address - Country:US
Practice Address - Phone:253-216-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00130458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse