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General NPI Number Information
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NPI Number | 1518139617
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Entity Type | Individual
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Provider Name | STACY M ANDERSON PMHNP
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Gender | Female
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1475 MT. HOOD AVE
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City | WOODBURN
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State | OR
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Zip | 97071
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Country | US
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Telephone | 971-983-5214
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Fax | 971-983-5219
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | WOODBURN
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State | OR
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Zip | 97071
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Country | US
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Telephone | 971-983-5260
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Fax | 971-983-5326
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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 | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 200850153NPPMHNP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 200850153NP
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License Number State | OR
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