Individual
SANDRA RAE HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
24223 9TH AVE S, DES MOINES, WA 98198-3881
(206) 878-2872
Mailing address
24223 9TH AVE S, DES MOINES, WA 98198-3881
(206) 878-2872
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
MA00012501
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6019476590010001
UBI NUMBER
WA
01
—
MA00012501
STATE LICENSE
WA
Enumeration date
11/14/2006
Last updated
08/04/2010
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