Provider Demographics
NPI:1730856998
Name:STORMER, MEREDITH ANN (NP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:STORMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15710 TOPAZ DR SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8526
Mailing Address - Country:US
Mailing Address - Phone:360-763-7040
Mailing Address - Fax:
Practice Address - Street 1:5128 YELM HWY SE STE E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5039
Practice Address - Country:US
Practice Address - Phone:360-763-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61214164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily