Provider Demographics
NPI:1770879652
Name:SILLDORFF, STEPHANY SUE (DNP, ARNP)
Entity type:Individual
Prefix:DR
First Name:STEPHANY
Middle Name:SUE
Last Name:SILLDORFF
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:STEPHANY
Other - Middle Name:SUE
Other - Last Name:NESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:SUITE G
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:15585 NE 24TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3836
Practice Address - Country:US
Practice Address - Phone:206-781-6080
Practice Address - Fax:206-781-6285
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60214925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily