Organization
SAGE ADULT AND GERIATRIC PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NINA VAN ES ANP/GNP (OWNER)
(541) 296-4804
Entity
Organization
Contact information
Practice address
1015 WEBBER ST STE 100, THE DALLES, OR 97058-3527
(541) 296-4804
(541) 296-3741
Mailing address
1015 WEBBER ST STE 100, THE DALLES, OR 97058-3527
(541) 296-4804
(541) 296-3741
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
200150061NP
OR
363LG0600X
Gerontology Nurse Practitioner
Primary
200150060NP
OR
Other
Enumeration date
11/30/2016
Last updated
11/30/2016
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