MEDICARE: DR. SANDRA MICHELLE WANEK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD22684	OR
2	2086S0102X	Surgical Critical Care Physician	2011029493	MO
3	2086S0102X	Surgical Critical Care Physician	MD22684	OR

General Provider Information

NPI Number	:	1912937137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA MICHELLE WANEK MD

Provider Business Mailing Address
First Line	:	PO BOX 13129
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97309-1129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 WINTER ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3934
Country	:	US
Telephone Number	:	503-561-2448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	04/30/2025

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