Provider Demographics
NPI:1437371879
Name:MCDONALD, SANDRA D (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:D
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 47210
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-7210
Mailing Address - Country:US
Mailing Address - Phone:206-763-8964
Mailing Address - Fax:
Practice Address - Street 1:7530 20TH AVE. S.W.
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106
Practice Address - Country:US
Practice Address - Phone:206-763-8964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7193777OtherPIN