Provider Demographics
NPI:1073817748
Name:FAN, SARAH FRANCES BUTLER (LAC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:FRANCES BUTLER
Last Name:FAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 SW 2ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2779
Mailing Address - Country:US
Mailing Address - Phone:503-877-5633
Mailing Address - Fax:503-350-1470
Practice Address - Street 1:12750 SW 2ND ST STE 102
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2779
Practice Address - Country:US
Practice Address - Phone:503-877-5633
Practice Address - Fax:503-350-1470
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153088171100000X
OR153088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist