Provider Demographics
NPI:1942241716
Name:DANCER, SANDRA E (ANP - C)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:E
Last Name:DANCER
Suffix:
Gender:F
Credentials:ANP - C
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:E
Other - Last Name:DANCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP-C
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:STE 6N50
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-216-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250087363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR100103Medicaid
ORP79456Medicare UPIN
OR100103Medicaid
ORR157775Medicare PIN
ORR118371Medicare PIN
ORR154807Medicare PIN
ORR141120Medicare PIN