1588733976 NPI number — KIM A WEEKS-NEWMAN LMP

Table of content: KIM A WEEKS-NEWMAN LMP (NPI 1588733976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588733976 NPI number — KIM A WEEKS-NEWMAN LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEEKS-NEWMAN
Provider First Name:
KIM
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMP
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:
1588733976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 PACIFIC AVE
Provider Second Line Business Mailing Address:
B-1
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-4001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-258-5454
Provider Business Mailing Address Fax Number:
425-258-1967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 PACIFIC AVE
Provider Second Line Business Practice Location Address:
B-1
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-258-5454
Provider Business Practice Location Address Fax Number:
425-258-1967
Provider Enumeration Date:
11/07/2006

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: 225700000X , with the licence number:  MA-00011993 , 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)