Provider Demographics
NPI:1295516052
Name:SANDERBRINK, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SANDERBRINK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33277 NIEBLOCK LN
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9748
Mailing Address - Country:US
Mailing Address - Phone:541-912-1363
Mailing Address - Fax:
Practice Address - Street 1:998 A ST
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-9633
Practice Address - Country:US
Practice Address - Phone:541-895-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201501527163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty