Healthcare Provider Details

I. General information

NPI: 1932023207
Provider Name (Legal Business Name): STACY MARIE NP, LLC DBA REMEDY FUNCTIONAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9455 SW 80TH AVE
PORTLAND OR
97223-8966
US

IV. Provider business mailing address

PO BOX 2411
TUALATIN OR
97062-2411
US

V. Phone/Fax

Practice location:
  • Phone: 503-208-4610
  • Fax: 503-447-2700
Mailing address:
  • Phone: 503-208-4610
  • Fax: 503-447-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. STACY FUNCTIONAL RONQUILLO
Title or Position: OWNER
Credential: NP
Phone: 503-208-4610