# STEPHANIE NANI, DO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619285293
- **Authorized official:** DR. STEPHANIE NANI DO (OWNER/PRESIDENT)
- **Authorized official phone:** (503) 850-6935

## Contact information

- **Practice address:** 15962 BOONES FERRY ROAD, SUITE 204, LAKE OSWEGO, OR 97035
- **Practice address phone:** (503) 850-6935
- **Mailing address:** 15962 BOONES FERRY ROAD, SUITE 204, LAKE OSWEGO, OR 97035
- **Mailing address phone:** (503) 850-6935

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | DO175986 | OR | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 20A8801 | CA | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | DO175986 | OR | Yes |
| 208D00000X | General Practice Physician | DO175986 | OR | — |

## Other

- **Enumeration date:** 09/17/2010
- **Last updated:** 07/21/2022