Healthcare Provider Details

I. General information

NPI: 1467854067
Provider Name (Legal Business Name): SARA VANGEMERT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

PO BOX 94645
SEATTLE WA
98124-6945
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-3181
  • Fax:
Mailing address:
  • Phone: 425-407-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60506157
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: