Provider Demographics
NPI:1265546360
Name:STADIN, JENNIFER CHRISTINE (LMP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:STADIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:CHRISTINE
Other - Last Name:STEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1950 KEENE RD.
Mailing Address - Street 2:BLDG. J
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-947-5599
Mailing Address - Fax:509-374-3873
Practice Address - Street 1:1950 KEENE RD.
Practice Address - Street 2:BLDG. J
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-947-5599
Practice Address - Fax:509-374-3873
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014641174400000X
246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No174400000XOther Service ProvidersSpecialist