Healthcare Provider Details

I. General information

NPI: 1043458573
Provider Name (Legal Business Name): SANDRA MARIE FLANAGAN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA MARIE ELARDO RN,BSN

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92023 PURKERSON RD
JUNCTION CITY OR
97448-9426
US

IV. Provider business mailing address

PO BOX 19765
PORTLAND OR
97280-0765
US

V. Phone/Fax

Practice location:
  • Phone: 503-294-1006
  • Fax: 503-294-1006
Mailing address:
  • Phone: 503-294-1006
  • Fax: 503-294-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number079033083RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: