Provider Demographics
NPI:1699135525
Name:SANCHEZ, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0254
Mailing Address - Country:US
Mailing Address - Phone:541-751-0357
Mailing Address - Fax:541-751-9985
Practice Address - Street 1:400 VIRGINIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3444
Practice Address - Country:US
Practice Address - Phone:541-751-0357
Practice Address - Fax:541-751-9985
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201408548LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse