Provider Demographics
NPI:1629266093
Name:WAVERSVELD, SARA A (DPM)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:WAVERSVELD
Suffix:
Gender:F
Credentials:DPM
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:316 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:#201
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4252
Mailing Address - Country:US
Mailing Address - Phone:253-403-7002
Mailing Address - Fax:253-403-7001
Practice Address - Street 1:316 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:#201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4252
Practice Address - Country:US
Practice Address - Phone:253-403-7002
Practice Address - Fax:253-403-7001
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2012-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPO60088821213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist