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NPI Code Detail

MEDICARE: STASHA ANNE HORNBECK MS, RD, LD, CDE

MEDICARE: STASHA ANNE HORNBECK MS, RD, LD, CDE
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
1133V00000XRegistered Dietitian860OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144210949
Entity Type Code : Individual
Provider Name (Legal Business Name) : STASHA ANNE HORNBECK MS, RD, LD, CDE
Provider Business Mailing Address
First Line : 9800 SE SUNNYSIDE RD
Second Line :
City : CLACKAMAS
State : OR
Zip : 97015-9750
Country : US
Telephone Number : 503-571-3040
Fax Number : 503-571-3095
Provider Business Practice Location Address
First Line : 9800 SE SUNNYSIDE RD
Second Line :
City : CLACKAMAS
State : OR
Zip : 97015-9750
Country : US
Telephone Number : 503-571-3040
Fax Number : 503-571-3095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 03/07/2022

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