Provider Demographics
NPI:1760117220
Name:GERGES, SABAH NAGEEB
Entity Type:Individual
Prefix:
First Name:SABAH
Middle Name:NAGEEB
Last Name:GERGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NE GLISAN SUT #250
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-8084
Mailing Address - Country:US
Mailing Address - Phone:503-430-9072
Mailing Address - Fax:
Practice Address - Street 1:901 NE GLISAN ST STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2730
Practice Address - Country:US
Practice Address - Phone:503-430-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR104625163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR104625OtherPEER SUPPORT SPECIALIST
OR104625OtherCOMMUNITY HEALTH WORKER
OR104625OtherTRADITIONAL HEALTH WORKER
OR104625OtherDOULA
OR104625OtherHEALTH CARE INTERPRETER