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General NPI Number Information
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NPI Number | 1255909248
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Entity Type | Organization
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Legal Business Name | SANA PSYCHIATRY LLC
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 1002 SE 54TH AVE
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City | PORTLAND
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State | OR
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Zip | 97215-2654
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Country | US
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Telephone | 503-386-0729
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Fax | 503-386-0729
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Provider Business Mailing Address
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Address Line | 1002 SE 54TH AVE
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City | PORTLAND
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State | OR
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Zip | 97215-2654
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Country | US
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Telephone | 503-386-0729
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Fax | 503-386-0729
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Authorized Official
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Title or Position | OWNER & PRACTITIONER
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Name | SANA GOLDBERG
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Credential | PMHNP-BC
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Telephone | 971-717-4866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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