Basic Information
| Provider Information | |||||||||
| NPI: | 1285628974 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARDS | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1517 | ||||||||
| Address2: | |||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978010410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777081119 | ||||||||
| FaxNumber: | 5412788349 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 NE PARK PLAZA DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986845895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602548025 | ||||||||
| FaxNumber: | 3602548618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 38323 | WA | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | 38323 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8253379 | 05 | WA | MEDICAID |