Individual
STEPHANIE LOCICERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-6594
(503) 494-4285
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
(866) 617-6855
(503) 346-8015
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
23973
NY
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA213429
OR
Other
Enumeration date
05/16/2019
Last updated
07/17/2023
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