1629125935 NPI number — MARGARET MARY MCGUIRE-DALE NURSE PRACTITIONER

Table of content: MARGARET MARY MCGUIRE-DALE NURSE PRACTITIONER (NPI 1629125935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629125935 NPI number — MARGARET MARY MCGUIRE-DALE NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGUIRE-DALE
Provider First Name:
MARGARET
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGUIRE-DALE
Provider Other First Name:
PEGGY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1629125935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3727 NE MARTIN LUTHER KING JR BLVD
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALING
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97212-1112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-775-4931
Provider Business Mailing Address Fax Number:
503-788-7289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11516 SE MILL PLAIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 2-E
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-775-4931
Provider Business Practice Location Address Fax Number:
503-788-7289
Provider Enumeration Date:
01/05/2007

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: 363LW0102X , with the licence number:  000039296N7 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: AP30006172 , 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: 9656018 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000291 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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