Provider Demographics
NPI:1649929597
Name:BARNES, STEPHANIE KATHLEEN (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KATHLEEN
Last Name:BARNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-4160
Mailing Address - Country:US
Mailing Address - Phone:541-270-2735
Mailing Address - Fax:
Practice Address - Street 1:445 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2272
Practice Address - Country:US
Practice Address - Phone:541-967-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-19
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201404881RN163WP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse