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General NPI Number Information
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NPI Number | 1457072910
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Entity Type | Individual
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Provider Name | PETER EDWARD SANDONA
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Gender | Male
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 514 E BROADWAY AVE
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City | MONTESANO
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State | WA
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Zip | 98563-3815
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Country | US
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Telephone | 360-249-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 COLEMAN AVE NW
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City | OLYMPIA
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State | WA
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Zip | 98502-4496
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Country | US
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Telephone | 360-402-3202
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | CG61364978
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License Number State | WA
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