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General NPI Number Information
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NPI Number | 1003839424
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Entity Type | Individual
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Provider Name | CHRISTINE ANN STANEK NP
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 2859 STATE STREET SUITE 101
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City | MEDFORD
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State | OR
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Zip | 97504
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Country | US
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Telephone | 541-282-6505
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Fax | 541-282-6520
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Provider Business Mailing Address
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Address Line | 3524 HEATHROW WAY
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City | MEDFORD
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State | OR
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Zip | 97504-4004
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Country | US
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Telephone | 541-646-3505
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Fax | 541-646-3553
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 200450119NP
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License Number State | OR
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