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Individual

JILL ELLEN STACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP-BC

Contact information

Practice address
101 ELLIOTT AVE W STE 500, SEATTLE, WA 98119-4292
(808) 348-1472
Mailing address
713 SW 118TH ST, SEATTLE, WA 98146-2830
(808) 348-1472

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP61593905
WA

Other

Enumeration date
08/06/2024
Last updated
10/22/2024
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