Healthcare Provider Details

I. General information

NPI: 1962799353
Provider Name (Legal Business Name): SARA WOOD, ND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4085 SW 109TH AVE SUITE 200
BEAVERTON OR
97005-3000
US

IV. Provider business mailing address

5310 SW ERICKSON AVE
BEAVERTON OR
97005-3849
US

V. Phone/Fax

Practice location:
  • Phone: 503-643-1024
  • Fax: 503-644-1293
Mailing address:
  • Phone: 503-515-8183
  • Fax: 503-643-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number1551
License Number StateOR

VIII. Authorized Official

Name: DR. SARA GRACE WOOD
Title or Position: OWNER
Credential: ND
Phone: 503-515-8183