Provider Demographics
NPI:1669036976
Name:WALNER, STACI J (NP)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:J
Last Name:WALNER
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SW 7TH ST STEA205
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:877-522-1275
Mailing Address - Fax:833-888-7145
Practice Address - Street 1:3918 N SCHREIBER WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8395
Practice Address - Country:US
Practice Address - Phone:877-522-1275
Practice Address - Fax:833-888-7145
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID61171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner