Provider Demographics
NPI:1467639195
Name:DOWTON, STACEY JO (LMP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:JO
Last Name:DOWTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S PIONEER WAY
Mailing Address - Street 2:SUITE F - PMB-332
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4801
Mailing Address - Country:US
Mailing Address - Phone:509-855-1180
Mailing Address - Fax:
Practice Address - Street 1:529 E BROADWAY AVE
Practice Address - Street 2:STE B
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1723
Practice Address - Country:US
Practice Address - Phone:509-855-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022357171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor