Healthcare Provider Details

I. General information

NPI: 1598951501
Provider Name (Legal Business Name): CASSANDRA STELL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA WHITTINGTON FNP

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 NW FLANDERS ST STE 105
PORTLAND OR
97210-5409
US

IV. Provider business mailing address

2250 NW FLANDERS ST STE 105
PORTLAND OR
97210-5409
US

V. Phone/Fax

Practice location:
  • Phone: 503-444-8440
  • Fax:
Mailing address:
  • Phone: 503-238-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number096000176RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200850054
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number096000176RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: