Stacy Ronquillo, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10012143 Issued in OR

Practice address

9455 SW 80TH Ave
Portland, OR 97223-8966

Phone

(503) 208-4610

Fax

(503) 447-2700

NPI assigned

Jan 30, 2023

Last updated

Sep 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stacy Marie NP, LLC Dba Remedy Functional Medicine

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1932023207
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1811603079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2411",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970622411",
            "telephone_number": "503-208-4610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9455 SW 80TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972238966",
            "telephone_number": "503-208-4610",
            "fax_number": "503-447-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 3rd St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lake Oswego",
            "state": "OR",
            "postal_code": "970343082",
            "country_code": "US",
            "telephone_number": "503-208-4610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RONQUILLO",
        "first_name": "STACY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-30",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OR",
            "license": "10012143",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "10012143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy Loraine Rongone
• Amber Alene Ronhaar, M.S., CCC-SLP
• Mischa B Ronick, MD
• Tami Lynne Roniger, MS, OTR/L
• Ronin Therapy LLC
• Adrian Cypress Ronsse
• Andrew David Rontal, M.D.
• Ami Ronvelia
• Lisa D Rood, M.D.
• Megan Elizabeth Rood, LMT, BS

• Family Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.