Healthcare Provider Details

I. General information

NPI: 1336585827
Provider Name (Legal Business Name): SARAH ANN JEFFREY AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2013
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-3260
  • Fax: 509-474-3245
Mailing address:
  • Phone: 509-474-3280
  • Fax: 509-474-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61097063
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2013001079
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2012023791
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP61097063
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: