Provider Demographics
NPI:1821715509
Name:STEPHENS, SHANTELLE ALICIA (RN)
Entity Type:Individual
Prefix:
First Name:SHANTELLE
Middle Name:ALICIA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANTELLE
Other - Middle Name:ALICIA
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4007 ATLANTA LN
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8593
Mailing Address - Country:US
Mailing Address - Phone:509-420-0405
Mailing Address - Fax:
Practice Address - Street 1:4007 ATLANTA LN
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8593
Practice Address - Country:US
Practice Address - Phone:509-420-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60850819163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics