Healthcare Provider Details

I. General information

NPI: 1225026354
Provider Name (Legal Business Name): SARA E HOLT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12265 SW HALL BLVD
PORTLAND OR
97223-6232
US

IV. Provider business mailing address

7888 SW 87TH AVE
PORTLAND OR
97223-7008
US

V. Phone/Fax

Practice location:
  • Phone: 503-724-4474
  • Fax:
Mailing address:
  • Phone: 503-724-4474
  • Fax: 830-255-5817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP30006724
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP09400676N5
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP09400676N5
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: