Provider Demographics
NPI:1013951342
Name:STEHOUWER, ELLEN K (DO)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:K
Last Name:STEHOUWER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 TREMONT ST W
Mailing Address - Street 2:STE 200
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-0000
Mailing Address - Country:US
Mailing Address - Phone:360-876-2434
Mailing Address - Fax:360-876-2696
Practice Address - Street 1:20730 BOND RD NE STE 104
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9000
Practice Address - Country:US
Practice Address - Phone:360-626-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8359390Medicaid
7817436OtherAETNA
WA8931448OtherCRIME VICTIMS COMP
P00029282OtherRAILROAD MEDICARE
WA171376OtherLABOR & INDUSTRIES
WA171376OtherLABOR & INDUSTRIES
WAGAB37429Medicare PIN
WAG8852206Medicare PIN
G8871649Medicare PIN
P00029282OtherRAILROAD MEDICARE
WA171376OtherLABOR & INDUSTRIES
WA8931448OtherCRIME VICTIMS COMP
WAH59344Medicare UPIN