Provider Demographics
NPI:1750015657
Name:VITACCO, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:VITACCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10136 TERRA GLENN ST SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8793
Mailing Address - Country:US
Mailing Address - Phone:631-830-5181
Mailing Address - Fax:
Practice Address - Street 1:21120 MERIDIAN AVE E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338
Practice Address - Country:US
Practice Address - Phone:253-285-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program