Healthcare Provider Details

I. General information

NPI: 1134726979
Provider Name (Legal Business Name): SARA ELLER ARRT(R)(M)(CT)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 6905 MCBH
PEARL HARBOR HI
96734
US

IV. Provider business mailing address

8326 SILVERDALE WAY NW # B
SILVERDALE WA
98383-8506
US

V. Phone/Fax

Practice location:
  • Phone: 808-257-3365
  • Fax:
Mailing address:
  • Phone: 931-200-4971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number389692
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: