Provider Demographics
NPI:1326112178
Name:STUPFEL, PATRICIA LORRAINE (ANP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LORRAINE
Last Name:STUPFEL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0824
Mailing Address - Country:US
Mailing Address - Phone:503-371-8346
Mailing Address - Fax:503-371-8334
Practice Address - Street 1:1002 BELLEVUE ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4006
Practice Address - Country:US
Practice Address - Phone:503-814-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR89003099N3163WM0705X
OR089003099N3 ANP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR049148Medicaid
OR049148Medicaid
OR131119Medicare ID - Type Unspecified