1790901866 NPI number — MRS. SARAH B SWENSON L.M.P.

Table of content: MRS. SARAH B SWENSON L.M.P. (NPI 1790901866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790901866 NPI number — MRS. SARAH B SWENSON L.M.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWENSON
Provider First Name:
SARAH
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWENSON
Provider Other First Name:
SALLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790901866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8836 NE 161ST PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENMORE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98028-1615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-770-5235
Provider Business Mailing Address Fax Number:
425-483-9293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18404 102ND AVE NE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98011-3380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-770-5235
Provider Business Practice Location Address Fax Number:
425-483-9293
Provider Enumeration Date:
04/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA00020588 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)