Sara Derenge
Nurse Practitioner - Women's Health
1057 12th Ave
Longview
, Washington 98632-2509
Sara Derenge
Nurse Practitioner - Women's Health
1057 12th Ave
Longview
, Washington 98632-2509
(360) 414-1114
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About
Features
Specialties
- Nurse Practitioner - Women's Health
Languages spoken
- English
Location
First Address
- Sara Derenge
- 1057 12th Ave
- Longview, WA
- Zip : 98632-2509
- Fax : (360) 414-1114
- Phone : (360) 636-3892
Second Address
- Sara Derenge
- 1057 12th Ave
- Longview, WA
- Zip : 98632-2509
- Fax : (360) 414-1114
- Phone : (360) 636-3892
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LW0102X | Nurse Practitioner - Women's Health | AP30005950 | WA |
National Provider Identifier
| NPI | 1053326934 |
|---|---|
| Provider Name | Sara Derenge |
| First Address | Longview, WA 98632-2509 |
| Second Address | Longview, WA 98632-2509 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/07/2006 |
| Last Update Date | 23/11/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 9632449 | (05) | WA |
| P45557 | (02) | WA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.