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General NPI Number Information
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NPI Number | 1295628733
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Entity Type | Individual
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Provider Name | CONNOR STUBBE
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Gender | Male
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 6926 NE FOURTH PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-7254
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Country | US
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Telephone | 360-993-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 2724 385TH AVE N
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City | ABERDEEN
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State | SD
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Zip | 57401-8488
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Country | US
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Telephone | 605-377-5260
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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