Individual
SANDRA J YOUNGWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
3303 SW BOND AVE STE 7, PORTLAND, OR 97239-4501
(503) 494-6594
(503) 494-5385
Mailing address
3303 SW BOND AVE STE 7, PORTLAND, OR 97239-4501
(503) 494-6594
(503) 494-5385
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200550058NP
OR
363L00000X
Nurse Practitioner
AP30007006
WA
363LA2200X
Adult Health Nurse Practitioner
H156296
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01543023
RR MEDICARE PTAN
WA
01
—
P01628718
RR PTAN CWH
WA
Enumeration date
08/24/2005
Last updated
01/28/2020
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