Provider Demographics
NPI:1285628974
Name:RICHARDS, STEPHANIE JANE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JANE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:877-708-1119
Mailing Address - Fax:541-278-8349
Practice Address - Street 1:222 NE PARK PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5895
Practice Address - Country:US
Practice Address - Phone:360-254-8025
Practice Address - Fax:360-254-8618
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA38323208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8253379Medicaid
WAAB38801Medicare ID - Type Unspecified
WA8253379Medicaid
WAGAB38801Medicare PIN