Healthcare Provider Details

I. General information

NPI: 1639258734
Provider Name (Legal Business Name): CAROL ROGERS STAMPFER FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 NE BROADWAY ST
PORTLAND OR
97213-1422
US

IV. Provider business mailing address

4212 NE BROADWAY ST
PORTLAND OR
97213-1422
US

V. Phone/Fax

Practice location:
  • Phone: 503-382-7709
  • Fax: 503-382-7706
Mailing address:
  • Phone: 503-382-7709
  • Fax: 503-382-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number200550012NP PMHNP PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number83037966FNP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number200550012NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: