1689800187 NPI number — BLAIR LYNN MACDONALD LMP

Table of content: BLAIR LYNN MACDONALD LMP (NPI 1689800187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689800187 NPI number — BLAIR LYNN MACDONALD LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACDONALD
Provider First Name:
BLAIR
Provider Middle Name:
LYNN
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:
CRITTENDEN
Provider Other First Name:
BLAIR
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689800187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3033
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-3033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-739-0411
Provider Business Mailing Address Fax Number:
360-692-3469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11871 SILVERDALE WAY NW
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-9414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-739-0411
Provider Business Practice Location Address Fax Number:
360-692-3469
Provider Enumeration Date:
06/10/2009

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:  MA00021185 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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