Provider Demographics
NPI:1760854434
Name:STREETER-SEDILLOS, STEFANIE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:MARIE
Last Name:STREETER-SEDILLOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0127
Mailing Address - Country:US
Mailing Address - Phone:406-237-7000
Mailing Address - Fax:
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 160W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-237-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT36934363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical