STACY LANDERS (NPI# 1477973204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477973204 |
| Entity Type | Individual |
| Full Name | STACY LANDERS |
| Credential | PA-C |
| Practice Address |
1547 Ne 40th Ave Ste B Portland OR 97232-1862 |
| Mailing Address |
1909 Se Elliott Ave Portland OR 97214-4815 |
| Practice Telephone | 5032841937 |
| Mailing Telephone | 5037304704 |
| Enumeration Date | 2014-04-19 |
| Last Update Date | 2020-03-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 1112125 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA168821 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1547 NE 40TH AVE STE B |
| City | PORTLAND |
| State | OR |
| Zip Code | 97232-1862 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972505584 | Robert Provenzano | Internal Medicine | 1547 Ne 40th Ave Ste B, Portland, OR 97232-1862 | 2005-08-12 |
| 1215308200 | Sushil S Deshmukh | Internal Medicine | 1547 Ne 40th Ave Ste B, Portland, OR 97232 | 2015-10-15 |
| 1679903231 | Pacific Kidney & Hypertension, LLC | Internal Medicine | 1547 Ne 40th Ave Ste B, Portland, OR 97232-1862 | 2013-11-19 |
| 1063791291 | Cecille Marie Cueto Sales | Internal Medicine | 1547 Ne 40th Ave Ste B, Portland, OR 97232-1862 | 2011-08-05 |
| 1154518504 | Sonia Bynum | Internal Medicine | 1547 Ne 40th Ave Ste B, Portland, OR 97232-1862 | 2007-10-01 |
| 1023190469 | Supriya Khan | Internal Medicine | 1547 Ne 40th Ave Ste B, Portland, OR 97232-1862 | 2006-10-19 |
| 1467439547 | Sallie E Israelit | Internal Medicine | 1547 Ne 40th Ave Ste B, Portland, OR 97232-1862 | 2005-12-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881293215 | Oregon Change Clinic | Clinic/Center | 650 Ne Holladay Street, Suite 1600, Portland, OR 97232 | 2020-10-17 |
| 1154969947 | Lori Kristen Miracle | Acupuncturist | Kwan Yin Healing Arts Center East Inc, 3115 Ne Sandy Blvd. Suite 231, Portland, OR 97232 | 2019-12-12 |
| 1194285411 | Onampai Modina Soondarotok | Student in an Organized Health Care Education/Training Program | Ipp, Oregon Health & Science University, 2214 Lloyd Center, Portland, OR 97232 | 2019-03-22 |
| 1003399635 | Cathleen Nicole Wenberg | Social Worker | 1839 Ne Couch St, Portland, OR 97232 | 2018-09-10 |
| 1508350760 | Float North | Acupuncturist | 1617 Ne 17th Ave., Portland, OR 97232 | 2018-06-20 |
| 1629560719 | Rachael Lee Walters | Doula | 3005 Ne Hoyt St, Portland, OR 97232 | 2018-06-04 |
| 1225529431 | Jason Sutherland | Social Worker | 707 Ne Couch, Portland, OR 97232 | 2018-05-23 |
| 1770089245 | Richard Farwell Leman | Family Medicine | 800 Ne Oregon St., Suite 772, Portland, OR 97232 | 2018-04-03 |
| 1952803413 | Aleksandra Giedowyn Md PC | Family Medicine | 1923 Ne Broadway Street Suite 2, Portland, OR 97232 | 2018-03-01 |
| 1639680374 | Amanda Matteo | Counselor | 20 Ne 10th Ave, Portland, OR 97232 | 2017-10-20 |
| Find all providers in zip 97232 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073081428 | Ishah Marie Price | Physician Assistant | 30 Preble St Apt 663, Portland, ME 04101-4939 | 2018-11-04 |
| 1740797166 | Joseph Something | Physician Assistant | 4800 Sw 76th Ave, Portland, OR 97225-1804 | 2018-01-08 |
| 1235687013 | Satchel Harry | Physician Assistant | 417 Sw 117th Ave Fl 2, Portland, OR 97225-5924 | 2016-09-21 |
| 1922551910 | Ashley Crowell | Physician Assistant | 949 Nw Overton St Unit 306, Portland, OR 97209 | 2016-07-26 |
| 1871982975 | Colin Storz | Physician Assistant | 3623 N Borthwick Ave, Portland, OR 97227-1218 | 2015-01-13 |
| 1275888729 | Stephanie Calvin | Physician Assistant | 782 College St, Portland, TN 37148-2120 | 2012-07-20 |
| 1174800031 | Carolyn Frances Farrell | Physician Assistant | 450 N Graham St, Portland, OR 97227-1682 | 2011-11-07 |
| 1316130198 | Ronald W Kessler | Physician Assistant | 632 Brighton Ave, Portland, ME 04102-1017 | 2007-08-24 |
| 1124210778 | Honey E.l. Marques | Physician Assistant | 16279 Se Division St, Portland, OR 97236-1971 | 2007-08-16 |
| 1124177902 | Dmitriy Shore | Physician Assistant | 10305 Sw Park Way Ste 300, Portland, OR 97225-5033 | 2007-01-09 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.