Healthcare Provider Details

I. General information

NPI: 1144471913
Provider Name (Legal Business Name): SARAH LEOLA KEFFELER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ORONDO AVE
WENATCHEE WA
98801-2701
US

IV. Provider business mailing address

711 ORONDO AVE
WENATCHEE WA
98801-2701
US

V. Phone/Fax

Practice location:
  • Phone: 509-663-8861
  • Fax:
Mailing address:
  • Phone: 509-663-8861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number20439
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: