=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942551353
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH DANG FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2012
-----------------------------------------------------
Last Update Date | 06/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4212 SE DIVISION ST STE 150
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97206-1681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-418-1500
-----------------------------------------------------
Fax | 503-418-3939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4212 SE DIVISION ST STE 150
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97206-1681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-418-1500
-----------------------------------------------------
Fax | 503-418-3939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 201250119NP
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------