Provider Demographics
NPI:1740650134
Name:NELSON, SARA (WHNP-BC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 SW GRANDVIEW AVENUE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-479-8363
Mailing Address - Fax:541-476-2841
Practice Address - Street 1:1075 SW GRANDVIEW AVENUE, SUITE 200
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-479-8363
Practice Address - Fax:541-476-2841
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201507970NP-PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health