Provider Demographics
NPI:1285160754
Name:STUBBLEFIELD, JEANNIE MOORE (PHD)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:MOORE
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UW LABORATORY MEDICINE NW120
Mailing Address - Street 2:1959 PACIFIC STREET, BOX 357110
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7110
Mailing Address - Country:US
Mailing Address - Phone:615-579-3042
Mailing Address - Fax:
Practice Address - Street 1:UW LABORATORY MEDICINE NW120
Practice Address - Street 2:1959 PACIFIC STREET, BOX 357110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7110
Practice Address - Country:US
Practice Address - Phone:615-579-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician