Provider Demographics
NPI:1194617290
Name:STUBER, TAMMY M (APRN-NP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:STUBER
Suffix:
Gender:F
Credentials:APRN-NP
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 7897
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303-0193
Mailing Address - Country:US
Mailing Address - Phone:503-551-9873
Mailing Address - Fax:
Practice Address - Street 1:3465 DUNCAN AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0811
Practice Address - Country:US
Practice Address - Phone:503-551-9873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10047341363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health