Provider Demographics
NPI:1003578857
Name:SPERRING, STEPHANIE (MSCN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SPERRING
Suffix:
Gender:F
Credentials:MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17087 TUALATIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5335
Mailing Address - Country:US
Mailing Address - Phone:503-380-0574
Mailing Address - Fax:
Practice Address - Street 1:17087 TUALATIN ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5335
Practice Address - Country:US
Practice Address - Phone:503-380-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist