Healthcare Provider Details

I. General information

NPI: 1932362233
Provider Name (Legal Business Name): STEPHANIE ANN MOEN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 NE TRISHA DR
HILLSBORO OR
97124-4002
US

IV. Provider business mailing address

1990 NE TRISHA DR
HILLSBORO OR
97124-4002
US

V. Phone/Fax

Practice location:
  • Phone: 503-640-2030
  • Fax:
Mailing address:
  • Phone: 503-640-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number0923329684
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: