Provider Demographics
NPI:1578663142
Name:SIKES, SANDRA BALLEW (RN,BSN,MN WHCNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:BALLEW
Last Name:SIKES
Suffix:
Gender:F
Credentials:RN,BSN,MN WHCNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:KATHLEEN
Other - Last Name:BALLEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,BSN,MN WHCNP
Mailing Address - Street 1:3550 N INTERSTATE AVE
Mailing Address - Street 2:INTERSTATE MEDICAL OFFICE-EAST
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1196
Mailing Address - Country:US
Mailing Address - Phone:503-331-6283
Mailing Address - Fax:
Practice Address - Street 1:3550 N INTERSTATE AVE
Practice Address - Street 2:INTERSTATE MEDICAL OFFICE-EAST
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1196
Practice Address - Country:US
Practice Address - Phone:503-331-6283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430476163WX0003X
OR200550065NP363LW0102X
CANP9709363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient