Provider Demographics
NPI:1821387317
Name:DAVIS, SAGE KENDRA (EAMP (LAC))
Entity Type:Individual
Prefix:MS
First Name:SAGE
Middle Name:KENDRA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:EAMP (LAC)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 2ND AVE W # B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2624
Mailing Address - Country:US
Mailing Address - Phone:206-491-4432
Mailing Address - Fax:
Practice Address - Street 1:535 E SUNSET WAY
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3473
Practice Address - Country:US
Practice Address - Phone:206-491-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60109653171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist