Provider Demographics
NPI:1699814921
Name:CAIN, SANDRA M (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:CAIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MARIE
Other - Last Name:DAILY CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13614 NE 103RD ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5290
Mailing Address - Country:US
Mailing Address - Phone:425-827-8243
Mailing Address - Fax:
Practice Address - Street 1:2704 I ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-2411
Practice Address - Country:US
Practice Address - Phone:253-833-7444
Practice Address - Fax:253-735-4111
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN025801163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9622432Medicaid
WA568503Medicare UPIN
WA9622432Medicaid