Provider Demographics
NPI:1326692831
Name:SILLECK, STEPHANIE LUX (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LUX
Last Name:SILLECK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:18633 SE STARK ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-5468
Mailing Address - Country:US
Mailing Address - Phone:503-489-1760
Mailing Address - Fax:503-489-1763
Practice Address - Street 1:6924 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5256
Practice Address - Country:US
Practice Address - Phone:503-300-4111
Practice Address - Fax:503-954-2122
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR201905671NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty