Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 200450119NP | OR |
NPI | 1003839424 |
---|---|
Provider Name | Christine Ann Stanek |
First Address | Medford, OR 97504-4004 |
Second Address | Medford, OR 97504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q39971 | (02) | OR |
Z120982 | (02) | AZ |