1073701454 NPI number — HELEN G CORCORAN P.A.-C.

Table of content: HELEN G CORCORAN P.A.-C. (NPI 1073701454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073701454 NPI number — HELEN G CORCORAN P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORCORAN
Provider First Name:
HELEN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
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:
1073701454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16916 140TH AVE NE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WOODINVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98072-6957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-481-6363
Provider Business Mailing Address Fax Number:
425-488-4971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17311 135TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE A700
Provider Business Practice Location Address City Name:
WOODINVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-488-4944
Provider Business Practice Location Address Fax Number:
425-488-4942
Provider Enumeration Date:
10/10/2007

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:  PA10005273 , 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: PA10005273 . This is a "STATE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8495848 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com