Healthcare Provider Details

I. General information

NPI: 1356481741
Provider Name (Legal Business Name): SANDRA EHRHART RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 14TH AVE S
SEATTLE WA
98108-4813
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 206-762-0876
  • Fax: 206-763-1856
Mailing address:
  • Phone: 206-764-0112
  • Fax: 206-764-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number940930
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: