Provider Demographics
NPI:1114236783
Name:CANADAY, SANDRA DAWSON (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DAWSON
Last Name:CANADAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:AREVALO
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 98886
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-8886
Mailing Address - Country:US
Mailing Address - Phone:253-584-3577
Mailing Address - Fax:253-584-8916
Practice Address - Street 1:4909 108TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3724
Practice Address - Country:US
Practice Address - Phone:253-581-3075
Practice Address - Fax:253-581-3178
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60181508363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8957787Medicare PIN