Provider Demographics
NPI:1861434193
Name:ROMNEY, STACEY (FNP)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:ROMNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MEDICAL CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4314
Mailing Address - Country:US
Mailing Address - Phone:541-930-7222
Mailing Address - Fax:541-930-7220
Practice Address - Street 1:520 MEDICAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4314
Practice Address - Country:US
Practice Address - Phone:541-930-7222
Practice Address - Fax:541-930-7220
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR089006921N1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR212849Medicaid
OR212849Medicaid
OR112938Medicare ID - Type Unspecified