Provider Demographics
NPI:1437228426
Name:PURCELL, SIERA VICTORIA (MT)
Entity Type:Individual
Prefix:MRS
First Name:SIERA
Middle Name:VICTORIA
Last Name:PURCELL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 212TH ST SW STE 103
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7614
Mailing Address - Country:US
Mailing Address - Phone:425-444-3742
Mailing Address - Fax:
Practice Address - Street 1:7500 212TH ST SW STE 103
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7614
Practice Address - Country:US
Practice Address - Phone:425-444-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017669174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist