Provider Demographics
NPI:1639118896
Name:STILES, ELIZABETH ANNE (LMP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:STILES
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 1:1700 MAIN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671
Mailing Address - Country:US
Mailing Address - Phone:360-844-5973
Mailing Address - Fax:360-844-5974
Practice Address - Street 1:1700 MAIN STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671
Practice Address - Country:US
Practice Address - Phone:360-844-5973
Practice Address - Fax:360-844-5974
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA18891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist