Individual
STACI COLOVOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-7246
(503) 346-6961
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
(866) 617-6855
(503) 346-8015
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201403204NP-PP
OR
363LA2100X
Acute Care Nurse Practitioner
Primary
201403204NP-PP
OR
363LA2100X
Acute Care Nurse Practitioner
6527571-4405
UT
Other
Enumeration date
11/15/2012
Last updated
08/27/2025
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