Basic Information
Provider Information | |||||||||
NPI: | 1093912750 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STOEBIG | ||||||||
FirstName: | QUIRISPINA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8495 CRATER LAKE HWY | ||||||||
Address2: |   | ||||||||
City: | WHITE CITY | ||||||||
State: | OR | ||||||||
PostalCode: | 975033011 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5418262111 | ||||||||
FaxNumber: | 3045356618 | ||||||||
Practice Location | |||||||||
Address1: | 8495 CRATER LAKE HWY | ||||||||
Address2: |   | ||||||||
City: | WHITE CITY | ||||||||
State: | OR | ||||||||
PostalCode: | 975033011 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5418262111 | ||||||||
FaxNumber: | 5418303526 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/27/2007 | ||||||||
LastUpdateDate: | 05/25/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/25/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 201142226RN | OR | Y |   | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
ID Information
ID | Type | State | Issuer | Description | 568946544 | 01 |   | BCBS | OTHER | 5874 | 01 |   | HEALTH PARTNERS | OTHER | 236 | 05 | DC |   | MEDICAID |