Provider Demographics
NPI:1659423309
Name:FAHEY, SARA (CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:FAHEY
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:FITZHUGH
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3098
Practice Address - Country:US
Practice Address - Phone:503-418-4500
Practice Address - Fax:503-494-1678
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006157367A00000X
OR200250014NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1659423309Medicaid
WA8945654Medicare PIN