Individual
STACEY COHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 N GRAHAM ST STE 200, PORTLAND, OR 97227-1676
(503) 413-4134
Mailing address
PO BOX 4399, PORTLAND, OR 97208-4399
(503) 413-3900
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10004005
OR
Other
Enumeration date
02/06/2023
Last updated
02/09/2024
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