Basic Information
| Provider Information | |||||||||
| NPI: | 1104255785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILES | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | VIRGINIA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19020 33RD AVE W | ||||||||
| Address2: | STE 210 | ||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980364748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533015100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12040 NE 128TH ST | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980343013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258991800 | ||||||||
| FaxNumber: | 4258991804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2013 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA60448342 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | PA60448342 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | PA60448342 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0442216 | 01 | WA | L & I - SWEDISH RADIA | OTHER | 0442190 | 01 | WA | L & I - RADIA | OTHER | 0442225 | 01 | WA | L & I - SOUTH SOUND RADIOLOGY | OTHER | 0442192 | 01 | WA | L & I - RADIA | OTHER | 0442230 | 01 | WA | L & I - VANCOUVER RADIOLOGISTS | OTHER | 0442216 | 01 | WA | L & I - EVERGREEN RADIA | OTHER | 0442228 | 01 | WA | L & I - SEATTLE RADIOLOGY | OTHER | 2035102 | 05 | WA | MEDICAID |