Provider Demographics
NPI:1821037318
Name:SLOAN, NANCY L (ANP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:SLOAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17070 SE MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-4960
Mailing Address - Country:US
Mailing Address - Phone:503-345-5900
Mailing Address - Fax:503-652-8954
Practice Address - Street 1:17070 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-4960
Practice Address - Country:US
Practice Address - Phone:503-345-5900
Practice Address - Fax:503-652-8954
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20065001NP ANP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271044Medicaid
134464Medicare ID - Type Unspecified
P15738Medicare UPIN