1174063051 NPI number — MS. CLAUDETTE V. SELKRIDGE MC60489858

Table of content: MS. CLAUDETTE V. SELKRIDGE MC60489858 (NPI 1174063051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174063051 NPI number — MS. CLAUDETTE V. SELKRIDGE MC60489858

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SELKRIDGE
Provider First Name:
CLAUDETTE
Provider Middle Name:
V.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MC60489858
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:
1174063051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 366
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOODSPORT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-285-3400
Provider Business Mailing Address Fax Number:
360-930-6887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 N. OLYMPIC HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-258-3400
Provider Business Practice Location Address Fax Number:
360-930-6887
Provider Enumeration Date:
02/27/2017

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: 101Y00000X , with the licence number:  MC60489858 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: MC60489858 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)