Provider Demographics
NPI:1912246133
Name:BROUGHTON, STEPHANIE ZIMMERMAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ZIMMERMAN
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22200 BRIER RD
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8047
Mailing Address - Country:US
Mailing Address - Phone:425-431-1065
Mailing Address - Fax:425-431-7272
Practice Address - Street 1:22200 BRIER RD
Practice Address - Street 2:
Practice Address - City:BRIER
Practice Address - State:WA
Practice Address - Zip Code:98036-8047
Practice Address - Country:US
Practice Address - Phone:425-431-1065
Practice Address - Fax:425-431-7272
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00047708163W00000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care