Healthcare Provider Details

I. General information

NPI: 1831199157
Provider Name (Legal Business Name): SARRA VASHCHENKO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARRA HAGER PA-C

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W BAY DR NW SUITE 301
OLYMPIA WA
98502-4958
US

IV. Provider business mailing address

304 W BAY DR NW SUITE 301
OLYMPIA WA
98502-4958
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8760
  • Fax: 360-413-8839
Mailing address:
  • Phone: 360-413-8760
  • Fax: 360-413-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004738
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: