Healthcare Provider Details

I. General information

NPI: 1447161112
Provider Name (Legal Business Name): JOSHUA SUNDQUIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22160 HIGHWAY 20
BEND OR
97701-9405
US

IV. Provider business mailing address

21160 HWY 20
BEND OR
97701
US

V. Phone/Fax

Practice location:
  • Phone: 503-476-4470
  • Fax:
Mailing address:
  • Phone: 503-476-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number110742
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: