Basic Information
| Provider Information | |||||||||
| NPI: | 1467720292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POPPE | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | BYRAM | ||||||||
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| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BYRAM | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | BETH | ||||||||
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| OtherCredential: | ARNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 500 LILLY RD NE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604138250 | ||||||||
| FaxNumber: | 3604138830 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 LILLY RD NE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604138250 | ||||||||
| FaxNumber: | 3604138830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2011 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP60511419 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | RN60511417 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 0024169779 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | AP60511419 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.