MEDICARE: MRS. CASSANDRA STELL PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	096000176RN	OR
2	363LF0000X	Family Nurse Practitioner	200850054	OR
3	163WP0808X	Psychiatric/Mental Health Registered Nurse	096000176RN	OR

General Provider Information

NPI Number	:	1598951501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASSANDRA STELL PMHNP

Provider Business Mailing Address
First Line	:	2250 NW FLANDERS ST STE 105
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-5409
Country	:	US
Telephone Number	:	503-238-0769
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 NW FLANDERS ST STE 105
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-5409
Country	:	US
Telephone Number	:	503-444-8440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	12/06/2023

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