Sara Lynn Ettl, L.M.P.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA00011902 Issued in WA

Practice address

2501 Racquet LN
Yakima, WA 98902-6114

Phone

(509) 452-5155

Fax

(509) 452-5355

NPI assigned

Mar 29, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487774915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 N 36TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989022227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 RACQUET LN",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989026114",
            "telephone_number": "509-452-5155",
            "fax_number": "509-452-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTL",
        "first_name": "SARA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "L.M.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA00011902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Yakima, WA
• Providers in Yakima, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.