Individual
STACEY V WIMBERLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, LMT
Contact information
Practice address
365 NE KEARNEY AVE, BEND, OR 97701-4573
(541) 948-4823
Mailing address
3000 NE YELLOW RIBBON DR, BEND, OR 97701-7522
(541) 948-4823
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7644
OR
Other
Enumeration date
12/08/2011
Last updated
01/27/2014
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