Provider Demographics
NPI:1316305121
Name:COOK, SARI NATSU MATISOFF (PMHNP)
Entity type:Individual
Prefix:
First Name:SARI
Middle Name:NATSU MATISOFF
Last Name:COOK
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:SARI
Other - Middle Name:NATSU
Other - Last Name:MATISOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1827 NE 44TH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1827 NE 44TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1443
Practice Address - Country:US
Practice Address - Phone:503-477-4969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201506864RN163W00000X
OR201705731NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse