MEDICARE: SARAH B DICUGNO ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	RN00123662	WA
2	363LP0200X	Pediatric Nurse Practitioner	AP30006255	WA

General Provider Information

NPI Number	:	1134106115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH B DICUGNO ARNP

Provider Business Mailing Address
First Line	:	1706 MERIDIAN S
Second Line	:	SUITE 120
City	:	PUYALLUP
State	:	WA
Zip	:	98371-7516
Country	:	US
Telephone Number	:	253-848-8797
Fax Number	:	253-446-3239

Provider Business Practice Location Address
First Line	:	10004 204TH AVE E
Second Line	:	SUITE 1300
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-6535
Country	:	US
Telephone Number	:	253-848-8797
Fax Number	:	253-826-1264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	11/14/2011

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