Healthcare Provider Details

I. General information

NPI: 1487089678
Provider Name (Legal Business Name): STEFANI CORONA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 BUCK ST
WEST LINN OR
97068-2709
US

IV. Provider business mailing address

1691 BUCK ST
WEST LINN OR
97068-2709
US

V. Phone/Fax

Practice location:
  • Phone: 503-477-2082
  • Fax:
Mailing address:
  • Phone: 503-477-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number200640136RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: