Provider Demographics
NPI:1780878470
Name:STORM, SARA RUPPRECHT (LAC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:RUPPRECHT
Last Name:STORM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 32ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6802
Mailing Address - Country:US
Mailing Address - Phone:206-363-0909
Mailing Address - Fax:
Practice Address - Street 1:11512 32ND AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6802
Practice Address - Country:US
Practice Address - Phone:206-363-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000475171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist