Individual
STACI ANTAYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, BSN, MSN, FNP
Contact information
Practice address
3617 S PACIFIC HWY, MEDFORD, OR 97501-8957
(541) 535-6239
Mailing address
931 CHEVY WAY, MEDFORD, OR 97504-4127
(541) 690-3555
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200540315RN
OR
363LF0000X
Family Nurse Practitioner
Primary
10038520
OR
Other
Enumeration date
01/09/2025
Last updated
04/01/2025
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