Individual provider Active NPI

Sandra Lee Pearson, REGISTERED NURSE

  • Registered Nurse
  • Bonney Lake, WA
National Provider Identifier
1912348707
Registry record updated Jul 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN00111864 Issued in WA
Practice address
10412 178TH Ave E
Bonney Lake, WA 98391-5143
Phone
(253) 334-4756
NPI assigned
Jul 9, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN00111864 WA Primary

Addresses

Primary practice location

10412 178TH Ave E
Bonney Lake, WA 98391-5143

Mailing address

PO Box 1091
Sumner, WA 98390-0210
Phone (253) 334-4756

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RN00111864WAMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373328000000",
    "number": "1912348707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1091",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983900210",
            "telephone_number": "253-334-4756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10412 178TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983915143",
            "telephone_number": "253-334-4756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "SANDRA",
        "middle_name": "LEE",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-09",
        "last_updated": "2013-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00111864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonney Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; 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.