Healthcare Provider Details

I. General information

NPI: 1770611121
Provider Name (Legal Business Name): SARAH CONNEELY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 NE NORTON AVE
BEND OR
97701-4387
US

IV. Provider business mailing address

464 NE NORTON AVE
BEND OR
97701-4387
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-3358
  • Fax:
Mailing address:
  • Phone: 541-323-3358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number564141
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10021635
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: