Provider Demographics
NPI:1689300865
Name:EHRLICK, SAGE ANDREANA
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:ANDREANA
Last Name:EHRLICK
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 1:15622 92ND WAY SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8700
Mailing Address - Country:US
Mailing Address - Phone:970-301-2826
Mailing Address - Fax:
Practice Address - Street 1:5108 260TH ST E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-9609
Practice Address - Country:US
Practice Address - Phone:253-800-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61331456163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool