Provider Demographics
NPI:1770755472
Name:VENDELIN, SARA ANNE (LMP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:VENDELIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANNE
Other - Last Name:ROBERGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:816 N ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-6722
Mailing Address - Country:US
Mailing Address - Phone:206-271-3582
Mailing Address - Fax:
Practice Address - Street 1:816 N ANDERSON ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-6722
Practice Address - Country:US
Practice Address - Phone:206-271-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012618174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist