1790018653 NPI number — VIVIAN DALENEY LMP

Table of content: VIVIAN DALENEY LMP (NPI 1790018653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790018653 NPI number — VIVIAN DALENEY LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALENEY
Provider First Name:
VIVIAN
Provider Middle Name:
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:
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:
1790018653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1718 28TH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98144-4802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-351-6088
Provider Business Mailing Address Fax Number:
206-203-1742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14535 BEL RED RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-3907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-351-6088
Provider Business Practice Location Address Fax Number:
206-203-1742
Provider Enumeration Date:
09/10/2009

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:  MA60049004 , 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)