Provider Demographics
NPI:1801814579
Name:SACKMANN, MARGARET E (ARNP/GNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:E
Last Name:SACKMANN
Suffix:
Gender:F
Credentials:ARNP/GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 BEVERLY AVE NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1823
Mailing Address - Country:US
Mailing Address - Phone:253-797-6239
Mailing Address - Fax:253-927-2119
Practice Address - Street 1:5115 BEVERLY AVE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1823
Practice Address - Country:US
Practice Address - Phone:253-952-3130
Practice Address - Fax:253-927-2119
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001790363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2005946Medicaid
WAAP30001790OtherWA LICENSE
WA2005946Medicaid
WAG8888873Medicare PIN