Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1154553204 |
---|---|
Provider Name | Sara Elizabeth Heiberg |
First Address | Tacoma, WA 98405-4139 |
Second Address | Tacoma, WA 98405-4139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2009 |
Last Update Date | 22/04/2014 |