1790008217 NPI number — LORI ANN DREWS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790008217 NPI number — LORI ANN DREWS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORI ANN DREWS
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:
1790008217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8051
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98908-0051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-469-1903
Provider Business Mailing Address Fax Number:
509-469-1905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 E MOUNTAIN VIEW AVE
Provider Second Line Business Practice Location Address:
STE. 301
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-5802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-2460
Provider Business Practice Location Address Fax Number:
509-925-2461
Provider Enumeration Date:
03/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DREWS
Authorized Official First Name:
LORI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
509-469-1903

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  AP60123614 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SP0808X , with the licence number: AP60123614 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0261115 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2006899 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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