Basic Information
| Provider Information | |||||||||
| NPI: | 1285791079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANKUS | ||||||||
| FirstName: | SETH | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 POINT FOSDICK DR NW STE 111 | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539267344 | ||||||||
| FaxNumber: | 2534266344 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 POINT FOSDICK DR NW STE 111 | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539267344 | ||||||||
| FaxNumber: | 2534266344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 03/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | DO29116 | OR | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | OP00001885 | WA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 264258 | 01 | WA | STATE L&I | OTHER | 500605945 | 05 | OR | MEDICAID | 8388886 | 05 | WA | MEDICAID | 264261 | 01 | WA | STATE L&I | OTHER | 264263 | 01 | WA | STATE L&I | OTHER |