Basic Information
Provider Information
NPI: 1205411444
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRANK
FirstName: SARAH
MiddleName: JEAN
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 160
Address2:  
City: PENDLETON
State: OR
PostalCode: 978010160
CountryCode: US
TelephoneNumber: 5419669830
FaxNumber:  
Practice Location
Address1: 46314 TIMINE WAY
Address2:  
City: PENDLETON
State: OR
PostalCode: 978019417
CountryCode: US
TelephoneNumber: 5419669830
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/09/2021
LastUpdateDate: 03/09/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/09/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
405300000X17-CRM-009ORY    

No ID Information.


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