Provider Demographics
NPI:1760606107
Name:JENKINS, SARAH D (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:D
Last Name:JENKINS
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:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-0581
Mailing Address - Country:US
Mailing Address - Phone:253-224-1110
Mailing Address - Fax:
Practice Address - Street 1:3825 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-4939
Practice Address - Country:US
Practice Address - Phone:253-224-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA13753175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1352JEOtherREGENCE
WA135548OtherLABOR AND INDUSTRIES