Sacred Life LLC
Registered Nurse in Vancouver, WA. Organization (NPI-2).
NPI number1962093641
StatusActive
Last updated in NPPESJan 27, 2021
Details
- NPI
- 1962093641
- Entity type
- Organization (NPI-2)
- Legal business name
- Sacred Life LLC
- Organization subpart
- No
- Enumeration date
- Jan 27, 2021
- Certification date
- Jan 27, 2021
- Last updated
- Jan 27, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163W00000X | Registered Nurse | – | – | Yes |
Practice location
11412 Ne 50th AveVancouver, WA 98686-4418
Phone 360-699-6411
Mailing address
11412 Ne 50th AveVancouver, WA 98686-4418
Authorized official
Ivan Sobovoy
Owner
3607214303
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