1457335747 NPI number — HOLLY ANDERSON P.A.

Table of content: HOLLY ANDERSON P.A. (NPI 1457335747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457335747 NPI number — HOLLY ANDERSON P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
HOLLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1457335747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O BOX 50095
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 EASTLAKE AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-288-7490
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2005

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: 363A00000X , with the licence number:  PA60043081 , 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: 1069039 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MH9041043467 . This is a "PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP50102 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 465R5AN . This is a "BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01-21435 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 465R5AN . This is a "BCBS" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 2307523 . This is a "ARAZ" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 10091 . This is a "AVERA" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 958105700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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