Provider Demographics
NPI:1588272389
Name:GOLDBERG, SANA (BA, RN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SANA
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:BA, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 SE 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2654
Mailing Address - Country:US
Mailing Address - Phone:971-717-4866
Mailing Address - Fax:503-386-0729
Practice Address - Street 1:1002 SE 54TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2654
Practice Address - Country:US
Practice Address - Phone:503-386-0729
Practice Address - Fax:503-386-0729
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201608009RN163W00000X
WAAP61113620363LP0808X
OR202006871NP-PP363LP0808X
WARN61111255163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse