Healthcare Provider Details

I. General information

NPI: 1205472446
Provider Name (Legal Business Name): SARA SUNDSTROM CDCES, MS, RDN, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA HUDSON

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NE 139TH ST STE 460
VANCOUVER WA
98686-2325
US

IV. Provider business mailing address

PO BOX 2077
PORTLAND OR
97208-2077
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-2727
  • Fax:
Mailing address:
  • Phone: 503-413-3900
  • Fax: 503-413-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60798424
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberDI60798424
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: