1154464725 NPI number — MARGARET M MAINZER-CARTER LMP

Table of content: MARGARET M MAINZER-CARTER LMP (NPI 1154464725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154464725 NPI number — MARGARET M MAINZER-CARTER LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAINZER-CARTER
Provider First Name:
MARGARET
Provider Middle Name:
M
Provider Name Prefix Text:
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:
CARTER
Provider Other First Name:
MARGARET
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154464725
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:
PO BOX 236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98292-0236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-629-7145
Provider Business Mailing Address Fax Number:
360-629-9985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30327 56TH AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98292-7157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-629-7145
Provider Business Practice Location Address Fax Number:
360-629-9985
Provider Enumeration Date:
02/14/2007

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: 174400000X , with the licence number:  MA00009088 , 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: MA00009088 . This is a "STATE OF WA LICENSE NO." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 106762 . This is a "L&I PROVIDER NO." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CA0534 . This is a "REGENCE PROVIDER NO." identifier . This identifiers is of the category "OTHER".




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