Individual
STACY LANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1547 NE 40TH AVE STE B, PORTLAND, OR 97232-1862
(503) 284-1937
Mailing address
1840 E RAY RD, CHANDLER, AZ 85225-8720
(855) 397-0197
(800) 272-6512
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA168821
OR
363AM0700X
Medical Physician Assistant
PA168821
OR
363AM0700X
Medical Physician Assistant
PA61075846
WA
Other
Enumeration date
04/19/2014
Last updated
07/29/2022
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