Provider Demographics
NPI:1194060251
Name:CASEY, STEFANIE E (ARNP)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:E
Last Name:CASEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3390
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3390
Mailing Address - Country:US
Mailing Address - Phone:541-387-6455
Mailing Address - Fax:
Practice Address - Street 1:1108 JUNE ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1513
Practice Address - Country:US
Practice Address - Phone:541-387-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202000079NP-PP363LG0600X
WAAP60320123363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1194060251Medicaid
WAP01553358OtherRR PTAN
WAP01553358OtherRR PTAN