Basic Information
| Provider Information | |||||||||
| NPI: | 1376536706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1012 SOUTH THIRD STREET | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034133900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 295 SOUTH COLLEGE AVE. SUITE 1 | ||||||||
| Address2: | |||||||||
| City: | COLLEGE PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093828349 | ||||||||
| FaxNumber: | 5095934342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP30005581 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | AP30005581 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.