Provider Demographics
NPI:1215554068
Name:STORNIOLO, SARAH LOUISE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LOUISE
Last Name:STORNIOLO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 SE 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1382
Mailing Address - Country:US
Mailing Address - Phone:503-807-9174
Mailing Address - Fax:
Practice Address - Street 1:411 SE 65TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1382
Practice Address - Country:US
Practice Address - Phone:503-807-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN237887163W00000X
OR201700591RN163W00000X
OR202009555NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse