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General NPI Number Information
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NPI Number | 1629266093
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Entity Type | Individual
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Provider Name | SARA A WAVERSVELD D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 316 MARTIN LUTHER KING JR WAY #201
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City | TACOMA
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State | WA
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Zip | 98405-4252
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Country | US
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Telephone | 253-403-7002
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Fax | 253-403-7001
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Provider Business Mailing Address
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Address Line | 316 MARTIN LUTHER KING JR WAY #201
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City | TACOMA
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State | WA
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Zip | 98405-4252
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Country | US
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Telephone | 253-403-7002
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Fax | 253-403-7001
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO60088821
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO60088821
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License Number State | WA
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