Provider Demographics
NPI:1386373751
Name:BROWN, STEFANIE KU'ULEI (LMT, CPHT)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:KU'ULEI
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMT, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 DUBLIN AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1294
Mailing Address - Country:US
Mailing Address - Phone:541-357-8227
Mailing Address - Fax:
Practice Address - Street 1:457 DUBLIN AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-1294
Practice Address - Country:US
Practice Address - Phone:541-357-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23791225700000X
ORCPT-0014716183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty