Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP3004299 | WA |
NPI | 1003894965 |
---|---|
Provider Name | Sara R Husarik |
First Address | Puyallup, WA 98371-7516 |
Second Address | Puyallup, WA 98371-7516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2006 |
Last Update Date | 10/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1018068 | DSHS NUMBER (01) | WA |