1184774036 NPI number — LORRI JEAN BERGE ARNP

Table of content: LORRI JEAN BERGE ARNP (NPI 1184774036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184774036 NPI number — LORRI JEAN BERGE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGE
Provider First Name:
LORRI
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERGE
Provider Other First Name:
LORRAINE
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184774036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 4TH AVE
Provider Second Line Business Mailing Address:
SUITE 1500
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98164-1008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-256-0041
Provider Business Mailing Address Fax Number:
206-749-4339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 4TH AVE
Provider Second Line Business Practice Location Address:
SUITE 1500
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98164-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-256-0041
Provider Business Practice Location Address Fax Number:
206-749-4339
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  AP30006050 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9632498 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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