Provider Demographics
NPI:1891794517
Name:WICKENHAGEN, SARAH K (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:K
Last Name:WICKENHAGEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 NW 185TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8914
Mailing Address - Country:US
Mailing Address - Phone:503-439-1539
Mailing Address - Fax:503-439-8960
Practice Address - Street 1:1881 NW 185TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-8914
Practice Address - Country:US
Practice Address - Phone:503-439-1539
Practice Address - Fax:503-439-8960
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily