Provider Demographics
NPI:1265947881
Name:BARTELL, STEPHANIE RAE (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:BARTELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RAE
Other - Last Name:BORROZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1338 COMMERCE AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3726
Mailing Address - Country:US
Mailing Address - Phone:360-999-7749
Mailing Address - Fax:
Practice Address - Street 1:1338 COMMERCE AVE STE 303
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3726
Practice Address - Country:US
Practice Address - Phone:360-999-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60347100164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA$$$$$$$$$Medicaid