Stephanie Renee Blum, FNP
Individual provider Active NPI Primary Care Nurse Practitioner · Gig Harbor, WA
NPI 1104092857 · NPPES record last updated Aug 13, 2013
Key facts
- NPI
- 1104092857
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- AP60071587 (WA)
- Practice address
- 8824 96TH St NW
Gig Harbor, WA 98332-6303 - Phone
- (360) 600-7269
- NPI assigned
- May 2, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP60071587 | WA | MD | Primary Care Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | AP60071587 | WA | Yes |
Addresses
Primary practice location
8824 96TH St NW
Gig Harbor, WA 98332-6303
Mailing address
8824 96TH St NW
Gig Harbor, WA 98332-6303
Phone (360) 600-7269
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G8917373 | Other | WA | MEDICARE PTAN |
| 8507568 | Other | WA | DSHS |
| 8871633 | Other | WA | MEDICARE |
Other providers in Gig Harbor, WA
- Karla Marie Bloomquist
- Blue Crane Physical Therapy LLC
- Blue Moon Massage Studio, LLC
- Blue Speech Therapy, LLC
- Blue Waters Counseling, PLLC
- David Blunk
- Sara Boelman
- Annemarie Boeve
- Tabitha Mae Bohren
- Dillon Boland
All providers in Gig Harbor, WA · Primary Care Nurse Practitioner in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.