Healthcare Provider Details

I. General information

NPI: 1831163807
Provider Name (Legal Business Name): STACY EPSTEEN A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 SW HALL BLVD
TIGARD OR
97223-8809
US

IV. Provider business mailing address

10215 SW HALL BLVD
TIGARD OR
97223-8809
US

V. Phone/Fax

Practice location:
  • Phone: 503-245-2415
  • Fax: 503-244-5963
Mailing address:
  • Phone: 503-245-2415
  • Fax: 503-244-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number000039229N3
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: