Provider Demographics
NPI:1609017375
Name:WOODRUFF, SARA KAHEALANI (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KAHEALANI
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:945 GOETHALS DR STE 200
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3552
Practice Address - Country:US
Practice Address - Phone:509-942-2555
Practice Address - Fax:509-942-0321
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60454771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881785764OtherUROLOGY ASSOCIATES OF SAN LUIS OBISPO, INC
CA1881785764OtherUROLOGY ASSOCIATES OF SAN LUIS OBISPO, INC