Healthcare Provider Details

I. General information

NPI: 1023442175
Provider Name (Legal Business Name): SANDRA MEMENIS DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14516 SE MILL PLAIN BLVD
VANCOUVER WA
98684-7418
US

IV. Provider business mailing address

14516 SE MILL PLAIN BLVD
VANCOUVER WA
98684-7418
US

V. Phone/Fax

Practice location:
  • Phone: 360-892-1440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVT 60351789
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: