Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | PG189173 | OR |
N | 208600000X | Surgeon | PG189173 | OR |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD60951421 | WA |
NPI | 1023451317 |
---|---|
Provider Name | Sarah Layne Crandall |
First Address | Tacoma, WA 98407-3177 |
Second Address | Tacoma, WA 98407-3177 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2013 |
Last Update Date | 02/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2028295 | (05) | WA |