1346306404 NPI number — MS. JUDITH E. STACEY-ROBAR ARNP

Table of content: MS. JUDITH E. STACEY-ROBAR ARNP (NPI 1346306404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346306404 NPI number — MS. JUDITH E. STACEY-ROBAR ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STACEY-ROBAR
Provider First Name:
JUDITH
Provider Middle Name:
E.
Provider Name Prefix Text:
MS.
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:
1346306404
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:
10041 SE 220TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98031-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-520-7086
Provider Business Mailing Address Fax Number:
253-859-0043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1851 CENTRAL PL S
Provider Second Line Business Practice Location Address:
SUITE 123
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98030-7514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-520-3060
Provider Business Practice Location Address Fax Number:
253-859-0043
Provider Enumeration Date:
12/30/2006

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: 363LP0808X , with the licence number:  AP30006451 , 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: 9638511 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 227130100000 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8307-01 . This is a "PACIFICARE BEHAVIORAL HEA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5240ST . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007266542 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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