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Individual

MS. STACY CALDWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6099
(541) 382-4900
Mailing address
PO BOX 6048, BEND, OR 97708-6048
(541) 382-4900

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01399
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500633870
OR
Enumeration date
07/09/2007
Last updated
06/18/2024
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