Provider Demographics
NPI:1538494182
Name:MADDEN, SANDRA L (RN, CDE)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MADDEN
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:SIUCIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1624 S I ST
Mailing Address - Street 2:STE 206
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5016
Mailing Address - Country:US
Mailing Address - Phone:253-426-6753
Mailing Address - Fax:253-426-6014
Practice Address - Street 1:1624 S I ST
Practice Address - Street 2:STE 206
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5016
Practice Address - Country:US
Practice Address - Phone:253-426-6753
Practice Address - Fax:253-426-6014
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered