Healthcare Provider Details

I. General information

NPI: 1740996750
Provider Name (Legal Business Name): AMY K STOKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8643 NE BEECH ST
PORTLAND OR
97220-5012
US

IV. Provider business mailing address

1454 SE 58TH AVE
PORTLAND OR
97215-2730
US

V. Phone/Fax

Practice location:
  • Phone: 503-256-2151
  • Fax:
Mailing address:
  • Phone: 323-868-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number201803669RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: