1043202625 NPI number — HOLLY MICHELLE FORSTER MILLER

Table of content: DR. EDWARD J DICESARE PH.D. (NPI 1417157579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043202625 NPI number — HOLLY MICHELLE FORSTER MILLER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
HOLLY
Provider Middle Name:
MICHELLE FORSTER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FORSTER
Provider Other First Name:
HOLLY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1043202625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 TERRY AVE
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:
98101-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-223-7528
Provider Business Mailing Address Fax Number:
206-223-7577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 TERRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-223-7528
Provider Business Practice Location Address Fax Number:
206-223-7577
Provider Enumeration Date:
08/18/2005

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: 225100000X , with the licence number:  PT00008343 , 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: 650024223 . This is a "R/R MED PIERCE CNTY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2192FO . This is a "REGENCE BS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 650025726 . This is a "R/R MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8342636 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9058FO . This is a "BLUE SHIELD # VM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: US7533340 . This is a "AETNA PCP PIN VM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 069741 . This is a "GROUP HEALTH # VM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 157609 . This is a "DEPT OF L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8936256 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com