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General NPI Number Information
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NPI Number | 1922301308
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Entity Type | Individual
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Provider Name | SARA E BLACKMAN PA
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Gender | Female
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 2610 UHRMANN RD
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1123
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Country | US
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Telephone | 541-274-4171
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Fax | 541-274-4174
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Provider Business Mailing Address
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Address Line | PO BOX 2120
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City | PORTLAND
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State | OR
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Zip | 97208-2120
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Country | US
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Telephone | 541-274-4171
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1501413
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA215327
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License Number State | OR
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