Healthcare Provider Details

I. General information

NPI: 1760607444
Provider Name (Legal Business Name): JESSICA SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10507 156TH ST E BLDG B
PUYALLUP WA
98374-9361
US

IV. Provider business mailing address

9040 JACKSON AVENUE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-477-7008
  • Fax: 253-477-5051
Mailing address:
  • Phone: 253-477-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN00138414
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: