Provider Demographics
NPI:1871953448
Name:LANDESS, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:LANDESS
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 1:34321 SE COLORADO RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8265
Mailing Address - Country:US
Mailing Address - Phone:971-678-7969
Mailing Address - Fax:
Practice Address - Street 1:3415 SE POWELL BLVD.
Practice Address - Street 2:TRILLIUM FAMILY SERVICES
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-234-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide