Dr Patrice N Stevenson
Organization Active NPI Physical Medicine & Rehabilitation Physician · Puyallup, WA
NPI 1104128727 · NPPES record last updated Dec 2, 2010
Key facts
- NPI
- 1104128727
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- MD00022286 (WA)
- Legal business name
- DR PATRICE N STEVENSON
- Practice address
- 407 14TH Ave SE
Puyallup, WA 98372-3770 - Phone
- (253) 862-5138
- Fax
- (253) 862-5138
- NPI assigned
- Dec 2, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Patrice N Stevenson
- Title
- Physician
- Phone
- (253) 862-5138
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician |
208100000X | MD00022286 | WA | Yes |
Addresses
Primary practice location
407 14TH Ave SE
Puyallup, WA 98372-3770
Mailing address
4468 185TH Ave E
Lake Tapps, WA 98391-9112
Phone (253) 862-5138
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1002229 | Medicaid | WA | |
| 1340ST | Other | WA | WA REGENCE |
| 4079238 | Other | WA | AETNA |
| 0252586 | Other | WA | WA L & I |
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All providers in Puyallup, WA · Physical Medicine & Rehabilitation Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2010. 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.