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Stephanie Locicero

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

PECOS Enrollment

Based on the most recent information from CMS, provider Stephanie Locicero is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1659937456
Provider Type
Individual
Full Name
Locicero, Stephanie
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
5/16/2019
Last Updated
7/17/2023

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 494-6594

(503) 494-4285

Mailing Location

1400 SW 5th Ave Ste 500, Portland, OR 97201-5537

(866) 617-6855

(503) 346-8015

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA213429 Oregon
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License 23973 New York
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Stephanie Locicero

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Stucke, Stephanie Brooke

Skolnik, Kevin

Schell, Allison Lynn

Barwood, Gwen Lynn

Fay, Shannon

Kjornes, Briana

Holzmacher, Daniel

Felder, Kimberly Kay

Tartaglia, Ryan T

Moody, Samuel