1821144825 NPI number — SUSAN T VALENTINE PAC

Table of content: SUSAN T VALENTINE PAC (NPI 1821144825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821144825 NPI number — SUSAN T VALENTINE PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALENTINE
Provider First Name:
SUSAN
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
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:
1821144825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 OLIVE WAY MSC M4-PA
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:
98101-1873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-515-5811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 WINSLOW WAY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAINBRIDGE ISLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98110-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-842-5631
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2007

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: 363A00000X , with the licence number:  PA10004374 , 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)

  • Identifier: 8368383 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4156VA . This is a "BLUE SHIELD #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: US7075460 . This is a "AETNA SPECIALIST PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0039581 . This is a "LABOR AND INDUSTRIES #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00044828 . This is a "RAILROAD MC#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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