Provider Demographics
NPI: | 1679973937 |
---|---|
Name: | MARTIN-WASHO, SARA ANN (ARNP, RN, RPSGT, RRT) |
Entity type: | Individual |
Prefix: | DR |
First Name: | SARA |
Middle Name: | ANN |
Last Name: | MARTIN-WASHO |
Suffix: | |
Gender: | F |
Credentials: | ARNP, RN, RPSGT, RRT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 60 COLUMBIA DR |
Mailing Address - Street 2: | |
Mailing Address - City: | KETTLE FALLS |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 99141-9461 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 206-550-5871 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 39 SHORTCUT RD |
Practice Address - Street 2: | |
Practice Address - City: | INCHELIUM |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98138-0290 |
Practice Address - Country: | US |
Practice Address - Phone: | 509-722-7006 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2014-08-23 |
Last Update Date: | 2023-01-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | RN 60225874 | 163WC1500X, 163WC1600X, 163WC2100X, 163WG0000X, 163WW0000X, 174H00000X |
WA | AP61359225 | 2083P0901X, 363L00000X, 363LP2300X, 363LF0000X |
WA | LR 00002646 | 227800000X, 227900000X, 2279G1100X, 246ZE0600X, 246ZE0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health |
No | 163WC1600X | Nursing Service Providers | Registered Nurse | Continuing Education/Staff Development |
No | 163WC2100X | Nursing Service Providers | Registered Nurse | Continence Care |
No | 163WG0000X | Nursing Service Providers | Registered Nurse | General Practice |
No | 163WW0000X | Nursing Service Providers | Registered Nurse | Wound Care |
No | 174H00000X | Other Service Providers | Health Educator | |
No | 2083P0901X | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
No | 227800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | |
No | 227900000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | |
No | 2279G1100X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | General Care |
No | 246ZE0600X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 1679973937 | Medicaid |