Healthcare Provider Details

I. General information

NPI: 1689648024
Provider Name (Legal Business Name): SANDRA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 SW NYE ST
NEWPORT OR
97365-3821
US

IV. Provider business mailing address

PO BOX 252
TOLEDO OR
97391-0252
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-6611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: