Provider Demographics
NPI:1831410455
Name:STAPPLER, ALICE RACHEL (PA)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:RACHEL
Last Name:STAPPLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2045
Mailing Address - Country:US
Mailing Address - Phone:541-267-1515
Mailing Address - Fax:541-266-4501
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2045
Practice Address - Country:US
Practice Address - Phone:541-267-1515
Practice Address - Fax:541-266-4501
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA152139363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-0635514OtherNBMC GROUP TAX ID FOR BILLING
OR161133OtherNBMC GROUP MEDICAID
ORR0000WFBTVOtherNBMC GROUP MEDICARE NUMBER
OR1407812365OtherNBMC GROUP NPI
ORPA152139OtherSTATE OF OREGON