Provider Demographics
NPI:1487952602
Name:TOMAN, STEPHANIE ZOE LADOUCEUR (FNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ZOE LADOUCEUR
Last Name:TOMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12518 NE AIRPORT WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1090
Mailing Address - Country:US
Mailing Address - Phone:503-256-2992
Mailing Address - Fax:
Practice Address - Street 1:12518 NE AIRPORT WAY STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1090
Practice Address - Country:US
Practice Address - Phone:503-256-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050096NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner