Provider Demographics
NPI:1487089678
Name:CORONA, STEFANI (RN)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:CORONA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 BUCK ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2709
Mailing Address - Country:US
Mailing Address - Phone:503-477-2082
Mailing Address - Fax:
Practice Address - Street 1:1691 BUCK ST
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-2709
Practice Address - Country:US
Practice Address - Phone:503-477-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200640136RN163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice