Healthcare Provider Details

I. General information

NPI: 1144853169
Provider Name (Legal Business Name): ALICIA LORRAINE STEARNS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA LORRAINE BENNER

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61250 SE COOMBS PL
BEND OR
97702-3704
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0002
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-5930
  • Fax: 541-706-5931
Mailing address:
  • Phone: 715-838-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4949-23
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4949
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: