1073055976 NPI number — MISS DEANNA LYNN HAGAN L.M.P

Table of content: LEMAUN A LANCASTER (NPI 1003259847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073055976 NPI number — MISS DEANNA LYNN HAGAN L.M.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGAN
Provider First Name:
DEANNA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
L.M.P
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:
1073055976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 M ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98002-4427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-333-8736
Provider Business Mailing Address Fax Number:
253-735-0902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 M ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-333-8736
Provider Business Practice Location Address Fax Number:
253-735-0902
Provider Enumeration Date:
11/08/2016

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:  MA60682422 , 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: MA60682422 . This is a "MASSAGE THERAPY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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