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General NPI Number Information
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NPI Number | 1487611380
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Entity Type | Individual
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Provider Name | MICHAEL L STAHLY FNP
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 1303 NE CUSHING DR
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City | BEND
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State | OR
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Zip | 97701-3730
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Country | US
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Telephone | 541-330-8226
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Fax | 541-318-0373
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Provider Business Mailing Address
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Address Line | 1303 NE CUSHING DR SUITE 100
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City | BEND
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State | OR
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Zip | 97701-3887
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Country | US
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Telephone | 541-388-2333
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 200540385RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 200550022NP
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200550023NP
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License Number State | OR
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