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NPI Code Detail

MEDICARE: SANDRA LASKI RN

MEDICARE: SANDRA LASKI RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse092003179OR

General Provider Information

NPI Number : 1578813648
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA LASKI RN
Provider Business Mailing Address
First Line : 4531 SE BELMONT ST
Second Line : SUITE # 100
City : PORTLAND
State : OR
Zip : 97215-1675
Country : US
Telephone Number : 503-215-7844
Fax Number : 503-215-7864
Provider Business Practice Location Address
First Line : 13007 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97230-2545
Country : US
Telephone Number : 503-215-7844
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2012
Last Update Date : 09/14/2012

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