Provider Demographics
NPI:1518391804
Name:KRAYNIK, SALLY ELIZABETH (MSN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ELIZABETH
Last Name:KRAYNIK
Suffix:
Gender:F
Credentials:MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4345
Mailing Address - Country:US
Mailing Address - Phone:503-486-7862
Mailing Address - Fax:833-266-6248
Practice Address - Street 1:1895 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4345
Practice Address - Country:US
Practice Address - Phone:503-486-7862
Practice Address - Fax:833-266-6248
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201393664NP-PP363L00000X
WAAP60463958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner