Individual
SUSANNE C STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5206 S STONE LN, SPOKANE, WA 99223-6524
(509) 443-1668
Mailing address
PO BOX 31297, SPOKANE, WA 99223-3021
(509) 443-1668
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004295
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA10004295
STATE LICENSE #
WA
Enumeration date
02/16/2007
Last updated
07/08/2007
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