Healthcare Provider Details

I. General information

NPI: 1285214601
Provider Name (Legal Business Name): STEPHANIE ELIZABETH NONAWZKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N GRAHAM ST STE 250
PORTLAND OR
97227-1651
US

IV. Provider business mailing address

5931 FILIAL ST
SACRAMENTO CA
95835-2743
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-2902
  • Fax:
Mailing address:
  • Phone: 315-748-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A23890
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO231332
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: