Basic Information
| Provider Information | |||||||||
| NPI: | 1114997244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STILES | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | WELDON | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2620 EAST BARNETT RD SUITE H | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417894281 | ||||||||
| FaxNumber: | 5417895538 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 MEDICAL CENTER DRIVE, SUITE 201 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417895710 | ||||||||
| FaxNumber: | 5417895711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NN07370300 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 201391437NN-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 191642 | 01 | NJ | AMERIGROUP | OTHER | 2364882 | 01 | NJ | UNITED HC | OTHER |