Individual provider Active NPI

Stephanie Mavin, DNP, ARNP, CPNP-PC

  • Registered Nurse
  • Tacoma, WA
National Provider Identifier
1508490160
Registry record updated Jul 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN00155873 Issued in WA
Practice address
311 S L St
Tacoma, WA 98405-3720
Phone
(253) 403-3481
NPI assigned
Feb 22, 2020
Last updated
Jul 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X AP61057765 WA
Registered Nurse 163W00000X RN00155873 WA Primary

Addresses

Primary practice location

311 S L St
Tacoma, WA 98405-3720

Mailing address

311 S L St
Tacoma, WA 98405-3720

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201001003223 WA Practitioner - Nurse Practitioner 5799104261 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN00155873WAMDRegistered Nurse
AP61057765WAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Sep 2, 2020 Accepting new patients
Multicare Health System CurrentSince Sep 2, 2020 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System Past Accepting new patients

Locations

200 Lilly Rd NE
Ste C
Olympia, WA 98506
Phone (360) 918-8336

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Interoperability endpoints

  • Direct secure messaging: smavinrn20370@direct.multicare.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593648000000",
    "number": "1508490160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 S L ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984053720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 S L ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984053720",
            "telephone_number": "253-403-3481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVIN",
        "first_name": "STEPHANIE",
        "credential": "DNP, ARNP, CPNP-PC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-22",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "AP61057765",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00155873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.