1649415720 NPI number — PACIFIC LUTHERAN UNIVERISTY STUDENT HEALTH CENTER

Table of content: (NPI 1649415720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649415720 NPI number — PACIFIC LUTHERAN UNIVERISTY STUDENT HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC LUTHERAN UNIVERISTY STUDENT HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1649415720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4018 CALDWELL RD E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98372-9234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-862-1050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PACIFIC LUTHERAN UNIVERSITY STUDENT HEALTH CTR
Provider Second Line Business Practice Location Address:
12012 PARK AVE SOUTH
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98447-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-535-7337
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
ANN
Authorized Official Middle Name:
WINNIFRED
Authorized Official Title or Position:
ARNP
Authorized Official Telephone Number:
253-862-7050

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  910565571 , 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)





Copyright © 2007-2024 www.npivalidator.com