Healthcare Provider Details

I. General information

NPI: 1700410214
Provider Name (Legal Business Name): SARAH EMMETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH BRYANT

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 NE KRESKY AVE
CHEHALIS WA
98532-2412
US

IV. Provider business mailing address

1408 MANLEY CT
FUQUAY VARINA NC
27526-5531
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-9595
  • Fax: 360-330-9560
Mailing address:
  • Phone: 919-906-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61041957
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61039525
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: