Basic Information
Provider Information | |||||||||
NPI: | 1629417241 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FAIRCHILD FRADETTE | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FAIRCHILD | ||||||||
OtherFirstName: | SARAH | ||||||||
OtherMiddleName: | ELIZABETH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 8980 161ST AVE NE | ||||||||
Address2: |   | ||||||||
City: | REDMOND | ||||||||
State: | WA | ||||||||
PostalCode: | 980527554 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4258992273 | ||||||||
FaxNumber: | 4258992272 | ||||||||
Practice Location | |||||||||
Address1: | 8980 161ST AVE NE | ||||||||
Address2: |   | ||||||||
City: | REDMOND | ||||||||
State: | WA | ||||||||
PostalCode: | 980527554 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4258992273 | ||||||||
FaxNumber: | 4258992272 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/17/2013 | ||||||||
LastUpdateDate: | 12/29/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 60688700 | WA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.