1083885065 NPI number — MS. DANA CORINNE HILL LMP

Table of content: MS. DANA CORINNE HILL LMP (NPI 1083885065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083885065 NPI number — MS. DANA CORINNE HILL LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
DANA
Provider Middle Name:
CORINNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIEHL
Provider Other First Name:
DANA
Provider Other Middle Name:
CORINNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083885065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3045
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
YELM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-458-2225
Provider Business Mailing Address Fax Number:
360-458-3663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 EAST YELM AVE #5
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
ROY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-458-2225
Provider Business Practice Location Address Fax Number:
360-458-3663
Provider Enumeration Date:
03/18/2008

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:  MA00021061 , 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)





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