Provider Demographics
NPI:1598538241
Name:TONACK, SYDNEY (PMHNP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:TONACK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11537 SW COLLINA LN
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7104
Mailing Address - Country:US
Mailing Address - Phone:503-860-7812
Mailing Address - Fax:
Practice Address - Street 1:10300 SW EASTRIDGE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5004
Practice Address - Country:US
Practice Address - Phone:503-944-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10018078363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health