Sandra Ann Banta Wright, NNP
Individual provider Active NPI Neonatal Nurse Practitioner · Portland, OR
NPI 1407943459 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1407943459
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neonatal Nurse Practitioner 363LN0000X
- License
- O84059397RN (OR)
- Practice address
- 707 SW Gaines St
Portland, OR 97239-2901 - Phone
- (800) 452-3563
- NPI assigned
- Oct 9, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O84059397N9 | OR | MD | Neonatal Nurse Practitioner |
| O84059397RN | OR | MD | Neonatal Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Emanuel Hospital & Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal Nurse Practitioner | 363LN0000X | O84059397RN | OR | Yes |
| Neonatal Nurse Practitioner | 363LN0000X | OR |
Addresses
Primary practice location
707 SW Gaines St
Portland, OR 97239-2901
Mailing address
7316 SE 13TH Ave
Portland, OR 97202-5922
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000552 | Medicaid | OR |
Other providers in Portland, OR
- Levi Patrick Banks
- Karly Andrea Keahi Bannister
- Natosha L Bannister
- Aisha Banse
- Modupe Desiree Bansile
- Corleen Angela Bantugon
- Brian Aoqi Bao
- Roman Baptista
- Asher Joshua Bar-Nes Caldwell
- Anna Alexandra Bar
All providers in Portland, OR · Neonatal Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.