Individual
MRS. STACY MARIE RUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6640 SW REDWOOD LN, PORTLAND, OR 97224-7187
(503) 620-7358
Mailing address
800 SW 13TH AVE, PORTLAND, OR 97205-1902
(503) 221-0161
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA179627
OR
Other
Enumeration date
02/27/2015
Last updated
11/18/2020
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