Healthcare Provider Details

I. General information

NPI: 1467399543
Provider Name (Legal Business Name): SADIE MAE HOLLINGSWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N GRANITE AVE
GRANITE FALLS WA
98252-8774
US

IV. Provider business mailing address

205 N ALDER AVE
GRANITE FALLS WA
98252-8907
US

V. Phone/Fax

Practice location:
  • Phone: 360-862-3893
  • Fax: 360-862-3893
Mailing address:
  • Phone: 360-691-7717
  • Fax: 360-283-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number61575940
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: