Healthcare Provider Details

I. General information

NPI: 1326112178
Provider Name (Legal Business Name): PATRICIA LORRAINE STUPFEL ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 BELLEVUE ST SE
SALEM OR
97301-4006
US

IV. Provider business mailing address

PO BOX 824
SALEM OR
97308-0824
US

V. Phone/Fax

Practice location:
  • Phone: 503-814-5352
  • Fax:
Mailing address:
  • Phone: 503-371-8346
  • Fax: 503-371-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number89003099N3
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number089003099N3 ANP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: