Basic Information
| Provider Information | |||||||||
| NPI: | 1831410455 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAPPLER | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | RACHEL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | COOS BAY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974202045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412671515 | ||||||||
| FaxNumber: | 5412664501 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | COOS BAY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974202045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412671515 | ||||||||
| FaxNumber: | 5412664501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2010 | ||||||||
| LastUpdateDate: | 04/02/2012 | ||||||||
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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 | 363A00000X | PA152139 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | PA152139 | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 93-0635514 | 01 | OR | NBMC GROUP TAX ID FOR BILLING | OTHER | 161133 | 01 | OR | NBMC GROUP MEDICAID | OTHER | R0000WFBTV | 01 | OR | NBMC GROUP MEDICARE NUMBER | OTHER | 1407812365 | 01 | OR | NBMC GROUP NPI | OTHER | PA152139 | 01 | OR | STATE OF OREGON | OTHER |