Provider Demographics
NPI:1639258734
Name:STAMPFER, CAROL ROGERS (FNP, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ROGERS
Last Name:STAMPFER
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1422
Mailing Address - Country:US
Mailing Address - Phone:503-382-7709
Mailing Address - Fax:503-382-7706
Practice Address - Street 1:4212 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1422
Practice Address - Country:US
Practice Address - Phone:503-382-7709
Practice Address - Fax:503-382-7706
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550012NP PMHNP PP163WP0807X
OR83037966FNP-PP163WP2201X
OR200550012NP101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5006205797Medicaid