STACEY L WILSON CNM NPI 1629102272

NPI Information

NPI: 1629102272
Provider Name: STACEY L WILSON, CNM
Classification: Nurse Practitioner - 363LX0001X
Entity Type: Individual

Specialization: Obstetrics & Gynecology

PECOS Registration: Yes

Address:
4855 SW WESTERN AVE
BEAVERTON, OR
ZIP 97005
Phone: (503) 626-5515
Get Directions

Stacey L Wilson, CNM is an obstetrics and gynecology nurse practitioner in Beaverton, OR. Stacey L Wilson, CNM NPI is 1629102272. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4855 SW WESTERN AVE
BEAVERTON, OR
ZIP 97005-460
Phone: (503) 626-5515

The NPI 1629102272 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 3/15/2007 and was last updated on 4/29/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LX0001X	Nurse Practitioner	Obstetrics & Gynecology	OR 200050017NP	OREGON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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