Individual
STACEY JEAN IWANIEC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1550 N 115TH ST, SEATTLE, WA 98133-8401
(206) 368-1008
Mailing address
209 28TH AVE S, SEATTLE, WA 98144-2413
(206) 992-6686
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
ST00000146
WA
Other
Enumeration date
11/25/2009
Last updated
11/25/2009
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