1417955147 NPI number — JANET LOUISE ANSPACH-RICKEY P.T. DIPMDT

Table of content: JANET LOUISE ANSPACH-RICKEY P.T. DIPMDT (NPI 1417955147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417955147 NPI number — JANET LOUISE ANSPACH-RICKEY P.T. DIPMDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANSPACH-RICKEY
Provider First Name:
JANET
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T. DIPMDT
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:
1417955147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30996 OLD HANSVILLE RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98346-9618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-638-1680
Provider Business Mailing Address Fax Number:
360-638-0299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8202 NE STATE HIGHWAY 104
Provider Second Line Business Practice Location Address:
SUITE 102, #40
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98346-9454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-638-1680
Provider Business Practice Location Address Fax Number:
360-638-0299
Provider Enumeration Date:
07/07/2005

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: 225100000X , with the licence number:  00003484 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X , with the licence number: 00003484 , 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: 8383861 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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