Provider Demographics
NPI:1447227921
Name:PERLMUTTER, SANDRA (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PERLMUTTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:550 17TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5788
Mailing Address - Country:US
Mailing Address - Phone:206-860-2302
Mailing Address - Fax:
Practice Address - Street 1:904 7TH AVE FL 7
Practice Address - Street 2:SUITE 400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1132
Practice Address - Country:US
Practice Address - Phone:206-860-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006307363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9635012Medicaid
WAAB32704Medicare ID - Type Unspecified
WA9635012Medicaid