Individual
STACY RONQUILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9455 SW 80TH AVE, PORTLAND, OR 97223-8966
(503) 208-4610
(503) 447-2700
Mailing address
PO BOX 2411, TUALATIN, OR 97062-2411
(503) 208-4610
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
10012143
OR
363LF0000X
Family Nurse Practitioner
Primary
10012143
OR
Other
Enumeration date
01/30/2023
Last updated
09/12/2024
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