Provider Demographics
NPI:1740287945
Name:BUSE, SARA A (FNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:BUSE
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 1:36860 INDUSTRIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-7371
Mailing Address - Country:US
Mailing Address - Phone:503-826-0206
Mailing Address - Fax:503-826-0216
Practice Address - Street 1:36860 INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-7371
Practice Address - Country:US
Practice Address - Phone:503-826-0206
Practice Address - Fax:503-826-0216
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200050045NP207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000227Medicaid
P49237Medicare UPIN
OR0000WCRCFMedicare ID - Type Unspecified