Individual
STACEY MARIE MERMIGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-5300
(503) 494-6519
Mailing address
7600 MONTGOMERY BLVD NE APT 1048, ALBUQUERQUE, NM 87109-1524
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN719449
PA
Other
Enumeration date
12/19/2022
Last updated
12/19/2022
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