Provider Demographics
NPI:1073569091
Name:COFFEY, STEFANIE R (DNP)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:R
Last Name:COFFEY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:R
Other - Last Name:CROSNOE, MUNDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1193
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 MULLINS DR STE 2
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3985
Practice Address - Country:US
Practice Address - Phone:541-451-7915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1698822363L00000X
OR201392013NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303482800Medicaid
FLE2284SMedicare PIN
FLE2284WMedicare ID - Type Unspecified
FLE2284TMedicare PIN
FL303482800Medicaid