Provider Demographics
NPI:1518081124
Name:SMITH, SANDRA JOY (LICENSED ACUPUNCTURI)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JOY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICENSED ACUPUNCTURI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17230 SKYRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-7773
Mailing Address - Country:US
Mailing Address - Phone:360-424-3227
Mailing Address - Fax:
Practice Address - Street 1:17230 SKYRIDGE CT
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-7773
Practice Address - Country:US
Practice Address - Phone:360-424-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA110171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist