1750408191 NPI number — DR. JENNIFER J CASEY N.D. DEGREE (NON-LIC

Table of content: DR. JENNIFER J CASEY N.D. DEGREE (NON-LIC (NPI 1750408191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750408191 NPI number — DR. JENNIFER J CASEY N.D. DEGREE (NON-LIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASEY
Provider First Name:
JENNIFER
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
N.D. DEGREE (NON-LIC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLD
Provider Other First Name:
HANDS
Provider Other Middle Name:
OF
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DNM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1750408191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 276
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97034-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-890-2888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12014 SE MILL PLAIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684-4043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-892-0199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2007

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: 225700000X , with the licence number:  8183 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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