Provider Demographics
NPI:1023312501
Name:ANDERSON, SARAH (MACOM,LAC, EAMP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MACOM,LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N CENTER PKWY
Mailing Address - Street 2:D303
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8214
Mailing Address - Country:US
Mailing Address - Phone:509-881-4365
Mailing Address - Fax:509-946-5132
Practice Address - Street 1:660 JADWIN AVE
Practice Address - Street 2:STE A
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4241
Practice Address - Country:US
Practice Address - Phone:509-943-5314
Practice Address - Fax:509-946-5132
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60200821171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist