Healthcare Provider Details

I. General information

NPI: 1760606107
Provider Name (Legal Business Name): SARAH D JENKINS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 6TH AVE
TACOMA WA
98406-4939
US

IV. Provider business mailing address

PO BOX 581
ROY WA
98580-0581
US

V. Phone/Fax

Practice location:
  • Phone: 253-224-1110
  • Fax:
Mailing address:
  • Phone: 253-224-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMA13753
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: