Provider Demographics
NPI:1003859638
Name:CONNER, SANDRA A (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:CONNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:A
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:11919 W. SPRAGUE
Mailing Address - Street 2:POB 1899
Mailing Address - City:AIRWAY HEIGHTS
Mailing Address - State:WA
Mailing Address - Zip Code:99001
Mailing Address - Country:US
Mailing Address - Phone:509-244-6700
Mailing Address - Fax:
Practice Address - Street 1:11919 W. SPRAGUE
Practice Address - Street 2:POB 1899
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001
Practice Address - Country:US
Practice Address - Phone:509-244-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9647652Medicaid
WA9647652Medicaid
8858654Medicare PIN