MEDICARE: MS. SARAH L GARDNER LAC.

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	171100000X	Acupuncturist	AC00000237	WA

General Provider Information

NPI Number	:	1700931169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH L GARDNER LAC.

Provider Business Mailing Address
First Line	:	14720 107TH WAY SW
Second Line	:
City	:	VASHON
State	:	WA
Zip	:	98070-3827
Country	:	US
Telephone Number	:	206-940-8802
Fax Number	:

Provider Business Practice Location Address
First Line	:	17917 VASHON HWY SW
Second Line	:
City	:	VASHON
State	:	WA
Zip	:	98070-5204
Country	:	US
Telephone Number	:	206-940-8802
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/09/2007

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