Basic Information
| Provider Information | |||||||||
| NPI: | 1730668161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYNES | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NEWMAN | ||||||||
| OtherFirstName: | SARAH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 589 NW 11TH ST | ||||||||
| Address2: | |||||||||
| City: | HERMISTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978386600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415671717 | ||||||||
| FaxNumber: | 5415645170 | ||||||||
| Practice Location | |||||||||
| Address1: | 589 NW 11TH ST | ||||||||
| Address2: | |||||||||
| City: | HERMISTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978386600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415671717 | ||||||||
| FaxNumber: | 5415645170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2018 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA190340 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.