Healthcare Provider Details

I. General information

NPI: 1790796597
Provider Name (Legal Business Name): SARA S PATTISON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 TOTEM BEACH RD
TULALIP WA
98271-6160
US

IV. Provider business mailing address

7520 TOTEM BEACH RD
TULALIP WA
98271-6160
US

V. Phone/Fax

Practice location:
  • Phone: 360-651-4511
  • Fax: 360-651-4591
Mailing address:
  • Phone: 360-651-4511
  • Fax: 360-651-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number762187
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: