Healthcare Provider Details

I. General information

NPI: 1932993615
Provider Name (Legal Business Name): ASHLEY SANDSNESS STUDENT, HEALTH CARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18633 SE STARK ST STE 401
PORTLAND OR
97233-5468
US

IV. Provider business mailing address

13847 LELAND RD
OREGON CITY OR
97045-9157
US

V. Phone/Fax

Practice location:
  • Phone: 503-489-1760
  • Fax:
Mailing address:
  • Phone: 503-539-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10063748
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: