Provider Demographics
NPI:1033540190
Name:SANGUINITY MOBILE MEDICAL
Entity Type:Organization
Organization Name:SANGUINITY MOBILE MEDICAL
Other - Org Name:SANGUINITY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ARLIN
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-540-7208
Mailing Address - Street 1:425 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WAITSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:99361-9742
Mailing Address - Country:US
Mailing Address - Phone:509-540-7208
Mailing Address - Fax:509-351-2043
Practice Address - Street 1:425 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WAITSBURG
Practice Address - State:WA
Practice Address - Zip Code:99361-9742
Practice Address - Country:US
Practice Address - Phone:509-540-7208
Practice Address - Fax:509-351-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60099171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty