1245257054 NPI number — ANN M FAILONI ARNP

Table of content: ANN M FAILONI ARNP (NPI 1245257054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245257054 NPI number — ANN M FAILONI ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAILONI
Provider First Name:
ANN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1245257054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 574
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT HADLOCK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98339-0574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
661 NESS CORNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HADLOCK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-912-5777
Provider Business Practice Location Address Fax Number:
206-472-6035
Provider Enumeration Date:
07/16/2006

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: 363LF0000X , with the licence number:  AP30005953 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: AP30005953 , 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: 423898079 . This is a "GROUP HEALTH COOPERATIVE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8937956 . This is a "L & I (CRIME VICTIM)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3976FA . This is a "REGENCE BLUESHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9635301 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0202595 . This is a "L & I (REGULAR)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 192942504 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00272186 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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