Healthcare Provider Details

I. General information

NPI: 1588387476
Provider Name (Legal Business Name): SARAH ST GERMAINE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 N 10TH AVE
PASCO WA
99301-4168
US

IV. Provider business mailing address

821 ROAD 54
PASCO WA
99301-2191
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-2474
  • Fax:
Mailing address:
  • Phone: 509-380-1614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00175740
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: