Provider Demographics
NPI:1821372483
Name:MANKOWSKI, SASHA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:MANKOWSKI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12503 SE MILL PLAIN BLVD STE 123
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4007
Mailing Address - Country:US
Mailing Address - Phone:360-334-9942
Mailing Address - Fax:425-242-3683
Practice Address - Street 1:12503 SE MILL PLAIN BLVD STE 123
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4007
Practice Address - Country:US
Practice Address - Phone:360-334-9942
Practice Address - Fax:425-242-3683
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201142866RN163W00000X
WAAP61044400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse