Healthcare Provider Details

I. General information

NPI: 1134106115
Provider Name (Legal Business Name): SARAH B DICUGNO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 204TH AVE E SUITE 1300
BONNEY LAKE WA
98391-6535
US

IV. Provider business mailing address

1706 MERIDIAN S SUITE 120
PUYALLUP WA
98371-7516
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-8797
  • Fax: 253-826-1264
Mailing address:
  • Phone: 253-848-8797
  • Fax: 253-446-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN00123662
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP30006255
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: