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NPI Code Detail

MEDICARE: SARA C'ERVENY GOODRUM

MEDICARE: SARA C'ERVENY GOODRUM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramWA

General Provider Information

NPI Number : 1730048489
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA C'ERVENY GOODRUM
Provider Business Mailing Address
First Line : 10125 160TH ST NE
Second Line :
City : ARLINGTON
State : WA
Zip : 98223-7513
Country : US
Telephone Number : 360-213-4677
Fax Number :
Provider Business Practice Location Address
First Line : 902 E MAPLE ST
Second Line :
City : ARLINGTON
State : WA
Zip : 98223-1634
Country : US
Telephone Number : 360-708-1765
Fax Number : 360-363-4235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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Directions to “ SARA C'ERVENY GOODRUM ” Practice Location

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