1245379650 NPI number — MRS. CHRISTINE LYNN MCCAMBRIDGE PMHNP-BC

Table of content: MRS. CHRISTINE LYNN MCCAMBRIDGE PMHNP-BC (NPI 1245379650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245379650 NPI number — MRS. CHRISTINE LYNN MCCAMBRIDGE PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCAMBRIDGE
Provider First Name:
CHRISTINE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245379650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 NE HIGHWAY 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97367-3240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-921-3584
Provider Business Mailing Address Fax Number:
541-614-1291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 NE HIGHWAY 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97367-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-921-3584
Provider Business Practice Location Address Fax Number:
541-614-1291
Provider Enumeration Date:
02/05/2007

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: 363LP0808X , with the licence number:  201602540NP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7004070 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2593248 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 500714310 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6113066 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175068 . This is a "RN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com