Provider Demographics
NPI:1831263953
Name:DAVIS-RISEN, SARA J
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:J
Last Name:DAVIS-RISEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:J
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:1321 NE 99TH AVE
Practice Address - Street 2:STE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9437
Practice Address - Country:US
Practice Address - Phone:503-215-9900
Practice Address - Fax:253-382-2091
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005107363AM0700X
ORPA156489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical