Provider Demographics
NPI:1164740395
Name:WINDSHEIMER, SARA ELLEN (BS)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:ELLEN
Last Name:WINDSHEIMER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:ELLEN
Other - Last Name:ROARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:3737 PORTLAND RD NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0311
Mailing Address - Country:US
Mailing Address - Phone:503-856-7034
Mailing Address - Fax:
Practice Address - Street 1:3737 PORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0311
Practice Address - Country:US
Practice Address - Phone:503-856-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR930903773Medicaid