Individual
SANDRA L BIRDLEBOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, ARNP
Contact information
Practice address
250 LOOMIS RD, PROSSER, WA 99350-8822
(509) 788-0750
Mailing address
250 LOOMIS RD, PROSSER, WA 99350-8822
(509) 788-0750
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PY00002504
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP30005617
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0195091
L&I
WA
05
—
9635871
—
WA
Enumeration date
10/17/2006
Last updated
07/31/2009
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