Healthcare Provider Details

I. General information

NPI: 1518287929
Provider Name (Legal Business Name): SARA LYN HURT LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAI LYN HURT LMP

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33650 6TH AVE S STE 100
FEDERAL WAY WA
98003-6754
US

IV. Provider business mailing address

33650 6TH AVE S STE 100
FEDERAL WAY WA
98003-6754
US

V. Phone/Fax

Practice location:
  • Phone: 253-942-3303
  • Fax:
Mailing address:
  • Phone: 253-942-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA60014299
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: