Healthcare Provider Details

I. General information

NPI: 1174757355
Provider Name (Legal Business Name): JAMIE VICTORIA STEVENSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 CENTENNIAL PLZ # 158
EUGENE OR
97401-2474
US

IV. Provider business mailing address

8915 SW CENTER ST
TIGARD OR
97223-6307
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-6340
  • Fax:
Mailing address:
  • Phone: 503-726-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202010497NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number202009099RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: