Provider Demographics
NPI:1174576094
Name:HELLBERG, SARA E (ARNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:HELLBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:E
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 34439
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1439
Mailing Address - Country:US
Mailing Address - Phone:509-522-5731
Mailing Address - Fax:509-522-5747
Practice Address - Street 1:401 W POPLAR ST
Practice Address - Street 2:CARDIOLOGY
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2846
Practice Address - Country:US
Practice Address - Phone:509-522-5731
Practice Address - Fax:509-522-5747
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00137707163W00000X
WAAP30007299363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1174576094Medicaid
WAG8905496Medicare PIN