Individual
STACEE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
212 E CENTRAL AVE, SUITE 440, SPOKANE, WA 99208-6291
(509) 489-2600
(509) 789-9064
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10005154
WA
363A00000X
Physician Assistant
PA703
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2413220
—
NV
Enumeration date
12/19/2005
Last updated
04/05/2021
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