Provider Demographics
NPI:1104379270
Name:FENTER, SANDRA (LMP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:FENTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:FENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:11126 SE 256TH ST
Mailing Address - Street 2:SUITE O203
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5633
Mailing Address - Country:US
Mailing Address - Phone:253-777-4298
Mailing Address - Fax:253-944-9196
Practice Address - Street 1:11126 SE 256TH ST
Practice Address - Street 2:SUITE O203
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5633
Practice Address - Country:US
Practice Address - Phone:253-777-4298
Practice Address - Fax:253-944-9196
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60526584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60526584OtherLMP