Individual
STACY VANTIGHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
5525 SW AMES WAY, PORTLAND, OR 97225-1003
(206) 669-3482
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
201041174RN
OR
163WM0705X
Medical-Surgical Registered Nurse
28373
MT
Other
Enumeration date
12/07/2010
Last updated
12/07/2010
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