Individual
STACI A ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
46314 TIMINE WAY, PENDLETON, OR 97801-9417
(541) 966-9830
Mailing address
PO BOX 160, PENDLETON, OR 97801-0160
(541) 966-9830
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
200842075RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200842075RN
OREGON BOARD OF NURSING
OR
Enumeration date
07/20/2022
Last updated
07/20/2022
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