1669409850 NPI number — MS. CHRISTINE MICHELE WILKE EDS LMFT

Table of content: MS. CHRISTINE MICHELE WILKE EDS LMFT (NPI 1669409850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669409850 NPI number — MS. CHRISTINE MICHELE WILKE EDS LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKE
Provider First Name:
CHRISTINE
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
EDS LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOMES
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669409850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 HILLVIEW DR
Provider Second Line Business Mailing Address:
A
Provider Business Mailing Address City Name:
NAZARETH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-746-3054
Provider Business Mailing Address Fax Number:
610-746-3054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 N THIRD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-746-3087
Provider Business Practice Location Address Fax Number:
610-746-3054
Provider Enumeration Date:
06/26/2006

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: 106H00000X , with the licence number:  MF000268 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50026970 . This is a "CBC GROUP NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50027094 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com