Provider Demographics
NPI:1609049006
Name:MCIVER, SARA MARIE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:MARIE
Last Name:MCIVER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8308 E MILL PLAIN BLVD
Mailing Address - Street 2:102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2066
Mailing Address - Country:US
Mailing Address - Phone:360-694-1118
Mailing Address - Fax:360-694-1979
Practice Address - Street 1:8308 E MILL PLAIN BLVD
Practice Address - Street 2:102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2066
Practice Address - Country:US
Practice Address - Phone:360-694-1118
Practice Address - Fax:360-694-1979
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023574174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist