Individual
STACI L KRISTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2211 NE 139TH ST, VANCOUVER, WA 98686-2742
(360) 487-1400
Mailing address
6312 SW CAPITOL HWY # 502, PORTLAND, OR 97239-1938
(503) 464-9034
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00044748
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234456
—
OR
05
—
8429110
—
WA
Enumeration date
07/27/2006
Last updated
07/07/2008
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