Provider Demographics
NPI:1205472446
Name:SUNDSTROM, SARA (CDCES, MS, RDN, CDN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SUNDSTROM
Suffix:
Gender:F
Credentials:CDCES, MS, RDN, CDN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2077
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-3710
Practice Address - Street 1:2101 NE 139TH ST STE 460
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2325
Practice Address - Country:US
Practice Address - Phone:360-487-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60798424133V00000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered