Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 02003485A | IN |
N | 208D00000X | General Practice Physician | 02003485B | IN |
N | 208D00000X | General Practice Physician | 268740 | NY |
Y | 208D00000X | General Practice Physician | OP00002318 | WA |
NPI | 1013127323 |
---|---|
Provider Name | Dr. Alanna Lauren Sandack |
First Address | University Place, WA 98466-5647 |
Second Address | University Place, WA 98466-5647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I39608 | (02) |