Provider Demographics
NPI:1255477048
Name:GREGORY, SARAH K (LMP, CNA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:K
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LMP, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12251 SE 59TH ST APT 106
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3844
Mailing Address - Country:US
Mailing Address - Phone:425-351-2911
Mailing Address - Fax:
Practice Address - Street 1:11520 NE 20TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3005
Practice Address - Country:US
Practice Address - Phone:425-646-4747
Practice Address - Fax:425-646-4770
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016852174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist