1407993900 NPI number — MS. SHANNON FREEMAN EAMP,DIPL.AC,LMP

Table of content: MS. SHANNON FREEMAN EAMP,DIPL.AC,LMP (NPI 1407993900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407993900 NPI number — MS. SHANNON FREEMAN EAMP,DIPL.AC,LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
SHANNON
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
EAMP,DIPL.AC,LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREEMAN
Provider Other First Name:
SHANNON
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
EAMP,DIPL.AC,LMP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407993900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1118 FINNEGAN WAY STE 201
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:
98225-6656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-366-4216
Provider Business Mailing Address Fax Number:
360-366-4241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1118 FINNEGAN WAY STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-6656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-366-4216
Provider Business Practice Location Address Fax Number:
360-366-4241
Provider Enumeration Date:
01/31/2007

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:  AC60254073 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: MA12766 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA12766 . This is a "WA MASSAGE LICENSE NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1932428919 . This is a "NPI: A BETTER WAY MASSAGE, LLC, FERNDALE, WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AC60254073 . This is a "WASHINGTON STATE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 6024SA . This is a "REGENCE PROVIDER NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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