1417099391 NPI number — DR. JEAN ANN EKVALL RD, DRPH, CHES, RN

Table of content: DR. JEAN ANN EKVALL RD, DRPH, CHES, RN (NPI 1417099391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417099391 NPI number — DR. JEAN ANN EKVALL RD, DRPH, CHES, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EKVALL
Provider First Name:
JEAN
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
RD, DRPH, CHES, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EKVALL
Provider Other First Name:
JEANNE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, DRPH, CHES, RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417099391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 337
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98812-0337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-689-2525
Provider Business Mailing Address Fax Number:
509-689-3247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 W INDIAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-689-2525
Provider Business Practice Location Address Fax Number:
509-689-3247
Provider Enumeration Date:
02/13/2007

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: 133V00000X , with the licence number:  DI00000848 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN00119314 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8260127 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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