Provider Demographics
NPI:1134579477
Name:SACK, MYOUNGHEE (RN)
Entity type:Individual
Prefix:
First Name:MYOUNGHEE
Middle Name:
Last Name:SACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 ANTHEM ST E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-3804
Mailing Address - Country:US
Mailing Address - Phone:253-337-4335
Mailing Address - Fax:
Practice Address - Street 1:6719 ANTHEM ST E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-3804
Practice Address - Country:US
Practice Address - Phone:253-337-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00159955163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse