Provider Demographics
NPI:1699122747
Name:ZELENKA, SANDRA (NP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ZELENKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 AERIAL WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9757
Mailing Address - Country:US
Mailing Address - Phone:541-242-8300
Mailing Address - Fax:541-242-8335
Practice Address - Street 1:1115 SE 164TH AVE
Practice Address - Street 2:DEPT 358
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9324
Practice Address - Country:US
Practice Address - Phone:360-729-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201601788NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner