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General NPI Number Information
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NPI Number | 1609697218
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Entity Type | Organization
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Legal Business Name | PACIFIC SAGE LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 527 NE BELLEVUE DR STE 200
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City | BEND
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State | OR
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Zip | 97701-8744
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Country | US
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Telephone | 541-640-7243
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Fax | 541-645-7243
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Provider Business Mailing Address
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Address Line | 2660 NE HIGHWAY 20 SUITE 610 #524
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City | BEND
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State | OR
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Zip | 97701
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Country | US
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Telephone | 541-762-2727
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Fax | 541-645-7243
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Authorized Official
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Title or Position | NP, OWNER
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Name | ANN OTTESEN
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Credential | AGPCNP (NP)
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Telephone | 541-762-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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