1386855591 NPI number — HEATHER ANN FAIRALL L.AC., MSAOM, EAMP

Table of content: HEATHER ANN FAIRALL L.AC., MSAOM, EAMP (NPI 1386855591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386855591 NPI number — HEATHER ANN FAIRALL L.AC., MSAOM, EAMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAIRALL
Provider First Name:
HEATHER
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.AC., MSAOM, EAMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FALKENBURY
Provider Other First Name:
HEATHER
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC., MSAOM, EAMP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386855591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29792
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98228-1792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-305-9224
Provider Business Mailing Address Fax Number:
855-230-4971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5683 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERNDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98248-8611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-305-9224
Provider Business Practice Location Address Fax Number:
855-230-4971
Provider Enumeration Date:
05/28/2007

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: 171100000X , with the licence number:  AC00002986 , 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)





Copyright © 2007-2024 www.npivalidator.com