Provider Demographics
NPI:1003100330
Name:JAPHET, SANDRA S (LMP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:JAPHET
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 SUMMIT LAKE SHORE RD NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-9455
Mailing Address - Country:US
Mailing Address - Phone:360-866-1361
Mailing Address - Fax:
Practice Address - Street 1:2127 SUMMIT LAKE SHORE RD NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-9455
Practice Address - Country:US
Practice Address - Phone:360-866-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60226737174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist