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General NPI Number Information
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NPI Number | 1336987791
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Entity Type | Individual
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Provider Name | STEFANI VANDENBERG CHW
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Gender | Female
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Dates
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Enumeration Date | 07/18/2024
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 37400 BELL ST
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City | SANDY
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State | OR
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Zip | 97055-7868
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Country | US
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Telephone | 971-220-2701
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Fax | 503-210-8681
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Provider Business Mailing Address
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Address Line | 37400 BELL ST
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City | SANDY
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State | OR
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Zip | 97055-7868
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Country | US
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Telephone | 971-220-2701
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Fax | 503-210-8681
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | THW000111507
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License Number State | OR
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