Individual
ELLEN PRISCILLA SAQUETON BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1003 PROVIDENCE DR, SUITE 210, NEWBERG, OR 97132-7521
(503) 537-5900
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD126320
OR
390200000X
Student in an Organized Health Care Education/Training Program
125052040
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500614683
—
OR
01
—
P01034673
RR MEDICARE
OR
Enumeration date
05/02/2007
Last updated
10/13/2020
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