Healthcare Provider Details

I. General information

NPI: 1144454877
Provider Name (Legal Business Name): SANDRA V LAW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2009
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-1000
  • Fax:
Mailing address:
  • Phone: 360-487-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberMD60282613
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD155918
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: