Individual
ELLEN B STEVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2801 N GANTENBEIN AVE, DEPARTMENT OF PEDIATRICS, LEGACY EMANUEL HOSPITAL, PORTLAND, OR 97227-1623
(503) 413-2402
(503) 413-2566
Mailing address
2801 N GANTENBEIN AVE, DEPARTMENT OF PEDIATRICS, LEGACY EMANUEL HOSPITAL, PORTLAND, OR 97227
(503) 413-2402
(503) 413-2566
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
046652
GA
208M00000X
Hospitalist Physician
Primary
MD27853
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000917936K
—
GA
05
—
270994
—
OR
05
—
8155160
—
WA
Enumeration date
06/23/2006
Last updated
06/29/2009
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