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Stephanie Brooke Stucke

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

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

PECOS Enrollment

This provider is enrolled in PECOS as STEPHANIE STUCKE.

Based on the most recent information from CMS, provider Stephanie Brooke Stucke 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
1730574260
Provider Type
Individual
Full Name
Stucke, Stephanie Brooke
Credential
PA

Gender
Female
Sole Proprietor
No
Enumeration Date
4/1/2015
Last Updated
12/28/2020

Contact Information

Practice Location

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

(503) 494-8122

(503) 494-4953

Mailing Location

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

(503) 494-8122

(503) 494-4953

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA196435 Oregon
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA196435 Oregon

Stephanie Brooke Stucke

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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Skolnik, Kevin

Anderson, Molly

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Kelly, Nicole

Mostafavifar, Mina

Bush, Lisa D

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Moody, Samuel