Provider Demographics
NPI:1649369505
Name:SCARBOROUGH, SARAH E (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:SCARBOROUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:55 W TIETAN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4498
Mailing Address - Country:US
Mailing Address - Phone:509-525-3720
Mailing Address - Fax:509-522-1592
Practice Address - Street 1:10 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:OR
Practice Address - Zip Code:97862-1799
Practice Address - Country:US
Practice Address - Phone:541-938-3314
Practice Address - Fax:541-938-4449
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232869Medicaid
WA9639931Medicaid
WA214257OtherL&I
WAP00392521OtherRAIL ROAD MEDICARE
WA9639931Medicaid
WAG8862127Medicare PIN
WAP00392521OtherRAIL ROAD MEDICARE