Healthcare Provider Details

I. General information

NPI: 1144208323
Provider Name (Legal Business Name): SARA ELIZABETH PRATT PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 CAPITAL MALL DR SW SUITE 100
OLYMPIA WA
98502-8701
US

IV. Provider business mailing address

3920 CAPITAL MALL DR SW SUITE 100
OLYMPIA WA
98502-8701
US

V. Phone/Fax

Practice location:
  • Phone: 360-753-4700
  • Fax: 360-753-6700
Mailing address:
  • Phone: 360-753-4700
  • Fax: 360-753-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004742
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: