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NPI Code Detail

MEDICARE: STEPHANIE NICOLE WHITE PA-C

MEDICARE: STEPHANIE NICOLE WHITE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA207934OR

General Provider Information

NPI Number : 1114680956
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE NICOLE WHITE PA-C
Provider Business Mailing Address
First Line : 501 N GRAHAM ST STE 415
Second Line :
City : PORTLAND
State : OR
Zip : 97227-2006
Country : US
Telephone Number : 503-413-3580
Fax Number :
Provider Business Practice Location Address
First Line : 501 N GRAHAM ST STE 415
Second Line :
City : PORTLAND
State : OR
Zip : 97227-2006
Country : US
Telephone Number : 503-413-3580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2021
Last Update Date : 10/19/2021

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Directions to “ STEPHANIE NICOLE WHITE PA-C” Practice Location

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