Provider Demographics
NPI:1386289239
Name:EICKHOFF, CLARA STEPHANIE (DNP, ARNP)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:STEPHANIE
Last Name:EICKHOFF
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 169TH ST S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8201
Mailing Address - Country:US
Mailing Address - Phone:253-538-4660
Mailing Address - Fax:253-538-4675
Practice Address - Street 1:144 169TH ST S
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8201
Practice Address - Country:US
Practice Address - Phone:253-538-4660
Practice Address - Fax:253-538-4675
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61082542363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2206610Medicaid