Provider Demographics
NPI:1992021059
Name:SKOVSTED, SONJA L (PA)
Entity Type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:L
Last Name:SKOVSTED
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:SONJA
Other - Middle Name:L
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2501 NW 229TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5506
Mailing Address - Country:US
Mailing Address - Phone:971-214-8422
Mailing Address - Fax:971-214-8607
Practice Address - Street 1:2501 NW 229TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5506
Practice Address - Country:US
Practice Address - Phone:971-214-8422
Practice Address - Fax:971-214-8607
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60120278363A00000X
WATA60120274363A00000X
ORPA154573363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant