Provider Demographics
NPI:1750268173
Name:STANTON, NICHOLAS LEE (PA-S)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LEE
Last Name:STANTON
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 G ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-1646
Mailing Address - Country:US
Mailing Address - Phone:951-377-6618
Mailing Address - Fax:
Practice Address - Street 1:2313 G ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-1646
Practice Address - Country:US
Practice Address - Phone:951-377-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant