Individual
STACEY ANN DAMAZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-1775
(503) 494-4749
Mailing address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-1775
(503) 494-4749
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2020012418
OR
363LF0000X
Family Nurse Practitioner
Primary
202011147NP-PP
OR
363LS0200X
School Nurse Practitioner
2020012418
OR
Other
Enumeration date
03/06/2021
Last updated
02/04/2022
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