Provider Demographics
NPI:1659713501
Name:VICHOREK, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:VICHOREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18123 36TH AVE W
Mailing Address - Street 2:#N102
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3838
Mailing Address - Country:US
Mailing Address - Phone:206-631-1555
Mailing Address - Fax:
Practice Address - Street 1:18123 36TH AVE W
Practice Address - Street 2:#N102
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3838
Practice Address - Country:US
Practice Address - Phone:206-631-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WANC60196731374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No374U00000XNursing Service Related ProvidersHome Health Aide