Provider Demographics
NPI:1043458573
Name:FLANAGAN, SANDRA MARIE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:MARIE
Other - Last Name:ELARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,BSN
Mailing Address - Street 1:PO BOX 19765
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97280-0765
Mailing Address - Country:US
Mailing Address - Phone:503-294-1006
Mailing Address - Fax:503-294-1006
Practice Address - Street 1:92023 PURKERSON RD
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-9426
Practice Address - Country:US
Practice Address - Phone:503-294-1006
Practice Address - Fax:503-294-1006
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079033083RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OREIN260813697Medicaid