Provider Demographics
NPI:1992027866
Name:STAIRS, BETHANY JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JEAN
Last Name:STAIRS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 NE 181ST AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6565
Mailing Address - Country:US
Mailing Address - Phone:503-489-1760
Mailing Address - Fax:
Practice Address - Street 1:124 NE 181ST AVE STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6565
Practice Address - Country:US
Practice Address - Phone:503-489-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily