Provider Demographics
NPI:1578258612
Name:KAISER, SAGE NAOMI (HCA)
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:NAOMI
Last Name:KAISER
Suffix:
Gender:F
Credentials:HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 AARON DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9042
Mailing Address - Country:US
Mailing Address - Phone:360-410-5482
Mailing Address - Fax:
Practice Address - Street 1:1125 AARON DR UNIT A
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9042
Practice Address - Country:US
Practice Address - Phone:360-410-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHM60978756374U00000X
WA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide