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General NPI Number Information
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NPI Number | 1205035136
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Entity Type | Individual
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Provider Name | ASTARA SUNRISE BURLINGAME RN LAC LMP RH
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Gender | Female
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 2603 BRIDGEPORT WAY W SUITE J UNIVERSITY PLACE
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4724
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Country | US
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Telephone | 206-370-0356
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Fax |
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Provider Business Mailing Address
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Address Line | 7040 S 12TH ST 3909
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City | TACOMA
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State | WA
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Zip | 98465-2727
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Country | US
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Telephone | 206-370-0356
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00000056
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA000001692
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00055978
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License Number State | WA
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