1285872606 NPI number — EDYTHE C. GARVEY ARNP

Table of content: EDYTHE C. GARVEY ARNP (NPI 1285872606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285872606 NPI number — EDYTHE C. GARVEY ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARVEY
Provider First Name:
EDYTHE
Provider Middle Name:
C.
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:
1285872606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E. KINCAID ST.
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALING
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98274-4127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-428-2500
Provider Business Mailing Address Fax Number:
360-428-6485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9631 - 269TH ST NW
Provider Second Line Business Practice Location Address:
SKAGIT REGIONAL CLINICS-STANWOOD
Provider Business Practice Location Address City Name:
STANWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-629-1600
Provider Business Practice Location Address Fax Number:
360-629-1644
Provider Enumeration Date:
01/22/2009

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:  AP60060843 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP60060843 , 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)