Provider Demographics
NPI:1760912943
Name:SAGMILLER, MARA (NP)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:SAGMILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:
Other - Last Name:LARAMEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9618 NE 103RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3343
Mailing Address - Country:US
Mailing Address - Phone:503-704-0078
Mailing Address - Fax:
Practice Address - Street 1:1420 JOHN ADAMS ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1609
Practice Address - Country:US
Practice Address - Phone:503-656-1484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201704423NP-PP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care