Provider Demographics
NPI:1063650216
Name:STUTZMAN, CECILIA DIANE (RN)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:DIANE
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CECILIA
Other - Middle Name:DIANE
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3750 CHEMAWA RD NE
Mailing Address - Street 2:CHEMAWA INDIAN HEALTH CENTER
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1111
Mailing Address - Country:US
Mailing Address - Phone:503-304-7600
Mailing Address - Fax:503-304-7678
Practice Address - Street 1:3750 CHEMAWA RD NE
Practice Address - Street 2:CHEMAWA INDIAN HEALTH CENTER
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1111
Practice Address - Country:US
Practice Address - Phone:503-304-7600
Practice Address - Fax:503-304-7678
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079043253RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse