Basic Information
| Provider Information | |||||||||
| NPI: | 1336176510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | CAVANAGH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1292 HIGH ST STE 224 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415002500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1800 COBURG RD | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974014995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416407625 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 160 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 101247 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 101247 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | PA193225 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | NCM603D | 01 | NC | MEDICARE PTAN | OTHER | NCM603C | 01 | NC | MEDICARE PTAN | OTHER | 0000431477 | 05 | MT | MEDICAID | NCM603A | 01 | NC | MEDICARE PTAN | OTHER | NCM603B | 01 | NC | MEDICARE PTAN | OTHER |