Individual
STACY C HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, DNP
Contact information
Practice address
4540 UNION BAY PL NE, SEATTLE, WA 98105-4025
(206) 320-3400
(206) 320-5773
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN60434895
WA
363LF0000X
Family Nurse Practitioner
Primary
AP61191864
WA
363LP2300X
Primary Care Nurse Practitioner
AP61191864
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730858879
—
WA
Enumeration date
09/11/2021
Last updated
01/17/2022
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