Healthcare Provider Details

I. General information

NPI: 1649783176
Provider Name (Legal Business Name): JOSEPH JUSTUS STANGER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NW 11TH ST STE E-15
HERMISTON OR
97838-6601
US

IV. Provider business mailing address

PO BOX 1517
PENDLETON OR
97801-0410
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-6434
  • Fax: 541-429-6613
Mailing address:
  • Phone: 541-278-4332
  • Fax: 541-278-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number200742518RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10015829
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: