1245370089 NPI number — MS. JUDY LYNN HAMMER LMP LICENSED MASSAGE

Table of content: MS. JUDY LYNN HAMMER LMP LICENSED MASSAGE (NPI 1245370089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245370089 NPI number — MS. JUDY LYNN HAMMER LMP LICENSED MASSAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMER
Provider First Name:
JUDY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMP LICENSED MASSAGE
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:
1245370089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1478
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANACORTES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98221-6478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-708-6535
Provider Business Mailing Address Fax Number:
360-230-3070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 M AVENUE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
ANACORTES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98221-4133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-708-6535
Provider Business Practice Location Address Fax Number:
888-896-9894
Provider Enumeration Date:
02/08/2007

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: 225700000X , with the licence number:  MA00013679 , 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: 0166112 . This is a "WA DEPT LABOR AND INDUSTR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 611739200 . This is a "US DEPT LABOR FECA NUMBER" identifier . This identifiers is of the category "OTHER".




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