Provider Demographics
NPI:1376973354
Name:NAJARRO, STEPHANIE INEZ (FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:INEZ
Last Name:NAJARRO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2175 NW RALEIGH ST STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2392
Practice Address - Country:US
Practice Address - Phone:888-803-3370
Practice Address - Fax:888-803-3331
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA813274163W00000X
OR202006210RN163W00000X
NYRN.503672163W00000X
WARN.503672163W00000X
CA95013632363LF0000X
FLAPRN11011790363LF0000X
NYAPRN.CNP.0030855363LF0000X
WAAPRN.CNP.0030855363LF0000X
OR202006669NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500782156Medicaid
CA95013632OtherNP LICENSE (BOARD OF REGISTERED NURSING)
OR202006669NPOtherNP LICENSE
CA813274OtherRN LICENSE