Provider Demographics
NPI:1154104636
Name:PODCZERVINSKI, SARA T (RN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:T
Last Name:PODCZERVINSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:T
Other - Last Name:DREITZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6306 188TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-7251
Mailing Address - Country:US
Mailing Address - Phone:206-418-8628
Mailing Address - Fax:
Practice Address - Street 1:1610 NE 150TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7224
Practice Address - Country:US
Practice Address - Phone:206-418-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00149128163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse