1396888715 NPI number — MS. ANN MARGARET PUTMAN PAC

Table of content: MS. ANN MARGARET PUTMAN PAC (NPI 1396888715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396888715 NPI number — MS. ANN MARGARET PUTMAN PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUTMAN
Provider First Name:
ANN
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOEHLER PUTMAN & COUGHLIN
Provider Other First Name:
ANN
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396888715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
518 E CLAY AVE
Provider Second Line Business Mailing Address:
PO BOX 198
Provider Business Mailing Address City Name:
CHEWELAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99109-8947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-935-8424
Provider Business Mailing Address Fax Number:
509-935-8402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
518 E CLAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEWELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99109-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-935-8424
Provider Business Practice Location Address Fax Number:
509-935-8402
Provider Enumeration Date:
02/15/2007

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: 363AM0700X , with the licence number:  PA10004381 , 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: 0194431 . This is a "LABOR & INDUSTRIES ID #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8416125 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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