1265542609 NPI number — JEAN SIGEL EMANUEL

Table of content: JEAN SIGEL EMANUEL (NPI 1265542609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265542609 NPI number — JEAN SIGEL EMANUEL

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EMANUEL
Provider Other First Name:
JEAN
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265542609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15436 BEL RED RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98052-5536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-644-4100
Provider Business Mailing Address Fax Number:
425-644-4101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15436 BEL RED RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98052-5536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-644-4100
Provider Business Practice Location Address Fax Number:
425-644-4101
Provider Enumeration Date:
08/30/2006

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: 101Y00000X , with the licence number:  RC00024506 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN00051122 , 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: 0144423 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".