1891800447 NPI number — ERNEST E HENNIGE MS

Table of content: ERNEST E HENNIGE MS (NPI 1891800447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891800447 NPI number — ERNEST E HENNIGE MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENNIGE
Provider First Name:
ERNEST
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENNIGE
Provider Other First Name:
GENE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1891800447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 EAST COLUMBIA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-684-3701
Provider Business Mailing Address Fax Number:
509-684-4180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
398 SOUTH MAIN
Provider Second Line Business Practice Location Address:
TOWN CENTER BLDG SUITE 207
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-685-7834
Provider Business Practice Location Address Fax Number:
509-685-2170
Provider Enumeration Date:
08/21/2006

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: 101Y00000X , with the licence number:  LH00004995 , 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: 8940562 . This is a "L&I CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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