Provider Demographics
NPI:1154839074
Name:SANBORN, CATHERINE (RN)
Entity type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:
Last Name:SANBORN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SE BELMONT ST APT 62
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2669
Mailing Address - Country:US
Mailing Address - Phone:603-275-0543
Mailing Address - Fax:
Practice Address - Street 1:916 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-5315
Practice Address - Country:US
Practice Address - Phone:503-803-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201509393RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health