Individual
STACY VANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
9385 SW MAPLEWOOD DR APT O172, PORTLAND, OR 97223-6169
(503) 475-8310
Mailing address
9385 SW MAPLEWOOD DR APT O172, PORTLAND, OR 97223-6169
(503) 475-8310
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201700628LPN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06161962
AVAMERE
OR
Enumeration date
05/15/2021
Last updated
05/15/2021
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