Healthcare Provider Details

I. General information

NPI: 1366750499
Provider Name (Legal Business Name): SARAH PATTERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ANTOS

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 SW 65TH AVE STE 100
TUALATIN OR
97062-7707
US

IV. Provider business mailing address

19250 SW 65TH AVE #100
TUALATIN OR
97062
US

V. Phone/Fax

Practice location:
  • Phone: 503-213-1658
  • Fax:
Mailing address:
  • Phone: 503-213-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201042845RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: