Provider Demographics
NPI:1326533373
Name:SANDWISCH, MICHELLE LEI (APRN, CNP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEI
Last Name:SANDWISCH
Suffix:
Gender:F
Credentials:APRN, CNP-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEI
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-4313
Mailing Address - Country:US
Mailing Address - Phone:425-441-3330
Mailing Address - Fax:253-466-3139
Practice Address - Street 1:317 4TH ST NW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-4313
Practice Address - Country:US
Practice Address - Phone:254-441-3330
Practice Address - Fax:425-466-3139
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022889363LF0000X
WAAP61033178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000000000OtherN/A