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General NPI Number Information
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NPI Number | 1740650134
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Entity Type | Individual
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Provider Name | SARA NELSON WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 1075 SW GRANDVIEW AVENUE, SUITE 200
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City | GRANTS PASS
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State | OR
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Zip | 97527
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Country | US
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Telephone | 541-479-8363
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Fax | 541-476-2841
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Provider Business Mailing Address
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Address Line | 1075 SW GRANDVIEW AVENUE, SUITE 200
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City | GRANTS PASS
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State | OR
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Zip | 97527
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Country | US
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Telephone | 541-479-8363
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Fax | 541-476-2841
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 201507970NP-PP
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License Number State | OR
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