Provider Demographics
NPI:1467697813
Name:BHARK, SANDRA LEE (ARNP, MSN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEE
Last Name:BHARK
Suffix:
Gender:F
Credentials:ARNP, MSN
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:KANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, MSN
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:751 NE BLAKELY DR STE 1090
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6201
Practice Address - Country:US
Practice Address - Phone:425-313-4200
Practice Address - Fax:425-313-4201
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00168186163W00000X
WAAP60041694363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse