1376625590 NPI number — MRS. PATRICE MARIE VAN DUINE ARNP, M.ED, PMHNP-BC

Table of content: MRS. PATRICE MARIE VAN DUINE ARNP, M.ED, PMHNP-BC (NPI 1376625590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376625590 NPI number — MRS. PATRICE MARIE VAN DUINE ARNP, M.ED, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN DUINE
Provider First Name:
PATRICE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP, M.ED, 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:
BORER
Provider Other First Name:
PATRICE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376625590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2722 COLBY AVE STE 328
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-3531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-740-3600
Provider Business Mailing Address Fax Number:
425-740-3601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2722 COLBY AVE. STE #328
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-3557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-740-3600
Provider Business Practice Location Address Fax Number:
425-740-3601
Provider Enumeration Date:
10/19/2006

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: 163WP0807X , with the licence number:  RN00059378 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X , with the licence number: RN00059378 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0809X , with the licence number: RN00059378 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP30007518 , 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: 11958223 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: AP30007518 . This is a "WA DEPT. OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: RN00059378 . This is a "WA DEPT. OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9659749 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".