Provider Demographics
NPI:1003694001
Name:STINE, CASEY LEE LUCY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LEE LUCY
Last Name:STINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LEE LUCY
Other - Last Name:ELDREDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3522
Mailing Address - Country:US
Mailing Address - Phone:541-608-6868
Mailing Address - Fax:
Practice Address - Street 1:500 MONROE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3522
Practice Address - Country:US
Practice Address - Phone:541-608-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker