STACEY L WILSON (NPI# 1629102272) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629102272 |
| Entity Type | Individual |
| Full Name | STACEY L WILSON |
| Credential | CNM |
| Practice Address |
4855 Sw Western Ave Beaverton OR 97005-3460 |
| Mailing Address |
8646 Nw Skyline Blvd Portland OR 97231-2618 |
| Practice Telephone | 5036265515 |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2008-04-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LX0001X |
Nurse Practitioner Specialization: Obstetrics & Gynecology |
OR 200050017NP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295217628 | Stacey Janette Wilson | Marriage & Family Therapist | 235 Michigan Avenue, Cary, NC 27519 | 2018-09-01 |
| 1760911176 | Stacey Lynn Wilson | Nurse Practitioner | 226 Madison 7875, Wesley, AR 72773 | 2017-06-08 |
| 1689100992 | Stacey Lynn Wilson | Physical Therapy Assistant | 3022 Yorktown Ct, Lafayette, IN 47909-3212 | 2017-05-05 |
| 1548670433 | Stacey Wilson | Behavioral Analyst | 8324 Cedar Chase Dr, Fountain, CO 80817-4030 | 2014-05-01 |
| 1477832558 | Stacey Wilson | Counselor | 100 Airport Rd #366, Mountain Village, AK 99632 | 2011-08-08 |
| 1548549801 | Stacey Elizabeth Wilson | Speech-Language Pathologist | 507 N Hook St, Tuscumbia, AL 35674-1867 | 2011-08-04 |
| 1609169689 | Stacey Wilson | Rehabilitation Practitioner | 4323 Banyan Ct, Sparks, NV 89436-0602 | 2011-05-24 |
| 1194981035 | Stacey Wilson | Pharmacist | 12078 Hwy 231 431 N, Meridianville, AL 35759-1225 | 2008-07-30 |
| 1609498849 | Stacey Wilson | Nurse Practitioner | 3 Saint Francis Dr, Greenville, SC 29601-3971 | 2020-05-11 |
| 1750883005 | Stacey Wilson | Social Worker | 6414 Oaklandon Rd, Indianapolis, IN 46236-2961 | 2018-03-02 |
| Street Address |
4855 SW WESTERN AVE |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97005-3460 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407827694 | Jennifer Mae Soyke | Family Medicine | 4855 Sw Western Ave, University of Oregon, Beaverton, OR 97005-3460 | 2006-01-27 |
| 1043857105 | Reagan Ravanzo Blanco | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-12-06 |
| 1144866591 | Asela Agtay Wells | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-11-20 |
| 1851935969 | Rosilyn Ricard | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-10-31 |
| 1063074789 | Blake Mcconnell | Student in an Organized Health Care Education/Training Program | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-07-02 |
| 1154886877 | Sarah Elizabeth Anderson Mills | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-02-06 |
| 1023506219 | Amanda Ellen Koonce | Student in an Organized Health Care Education/Training Program | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2018-04-24 |
| 1285142802 | Tiffani O'neill | Counselor | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2018-01-17 |
| 1912438953 | Dia Hazra | Pediatrics | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2017-03-22 |
| 1346782794 | Nicole Pollock | Pharmacist | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2016-11-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
| 1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
| 1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
| 1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
| 1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
| 1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
| 1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
| 1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
| Find all providers in zip 97005 | ||||
| Taxonomy Code | 363LX0001X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Obstetrics & Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366951303 | Angelina Rene Skokan | Nurse Practitioner | 12220 Sw 1st St Ste 200, Beaverton, OR 97005-2890 | 2017-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780291146 | Menopause Northwest, LLC | Nurse Practitioner | 2712 Se 43rd Ave, Portland, OR 97206-1608 | 2020-09-29 |
| 1124499124 | Nisha Jackson Inc. | Nurse Practitioner | 3236 Hillcrest Park Dr, Medford, OR 97504-7657 | 2015-10-15 |
| 1023384062 | Cheri Maureen Monteith | Nurse Practitioner | 2460 Biehn Stree, Suite 1, Klamath Falls, OR 97601-1181 | 2012-03-23 |
| 1134242167 | Patricia M. Reddy | Nurse Practitioner | 560 Catalina Dr # 200, Ashland, OR 97520-1605 | 2007-04-06 |
| 1275611733 | Adria Yvonne Goodness | Nurse Practitioner | 833 S.w. 11th Ave., Suite 915, Portland, OR 97205 | 2006-11-01 |
| 1336169911 | Virginia Lois Capan | Nurse Practitioner | 3181 Sw Jackson Park Blvd, Oregon Health & Science University, Portland, OR 97239 | 2006-07-19 |
| 1487617502 | Melissa Sheffield | Nurse Practitioner | 1373 N 10th Ave, Stayton, OR 97383-2037 | 2006-04-10 |
| 1376504225 | Karen M Roberson | Nurse Practitioner | 1813 W. Harvard Ave., Suite 542, Roseburg, OR 97471-2752 | 2006-03-30 |
| 1801865738 | Emily S Downing - Moore | Nurse Practitioner | 353 Deadmond Ferry Rd, Springfield, OR 97477-9406 | 2006-03-14 |
| 1508482332 | Shannon Leigh Sluys | Nurse Practitioner | 2700 Se Stratus Ave, Mcminnville, OR 97128-6255 | 2020-06-17 |
| Find all providers with the same taxonomy | ||||
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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.