Provider Demographics
NPI:1336232941
Name:HINSON, STEPHANIE CLARK (ARNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CLARK
Last Name:HINSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-1166
Mailing Address - Country:US
Mailing Address - Phone:425-258-7357
Mailing Address - Fax:425-258-7022
Practice Address - Street 1:900 PACIFIC AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4168
Practice Address - Country:US
Practice Address - Phone:425-304-6040
Practice Address - Fax:425-304-6045
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006422363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9641945Medicaid
WAQ19849Medicare UPIN
WA8805459Medicare ID - Type Unspecified