Basic Information
| Provider Information | |||||||||
| NPI: | 1023451317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRANDALL | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | LAYNE | ||||||||
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| Credential: | M.D., | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 MAIN ST STE 125 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984073177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537594529 | ||||||||
| FaxNumber: | 2539842049 | ||||||||
| Practice Location | |||||||||
| Address1: | 5005 MAIN ST STE 125 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984073177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537594529 | ||||||||
| FaxNumber: | 2539842049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2013 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | PG189173 | OR | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0122X | MD60951421 | WA | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2028295 | 05 | WA | MEDICAID |