Provider Demographics
NPI:1144208323
Name:PRATT, SARA ELIZABETH (PAC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:PRATT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 CAPITAL MALL DR SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8701
Mailing Address - Country:US
Mailing Address - Phone:360-753-4700
Mailing Address - Fax:360-753-6700
Practice Address - Street 1:3920 CAPITAL MALL DR SW
Practice Address - Street 2:SUITE 100
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8701
Practice Address - Country:US
Practice Address - Phone:360-753-4700
Practice Address - Fax:360-753-6700
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8409922Medicaid
WA8803402Medicare ID - Type Unspecified
WA8409922Medicaid