1457472581 NPI number — DR. JENNIFER VALIA SCHIAVONE-RUTHENSTEINER N.D.

Table of content: DR. JENNIFER VALIA SCHIAVONE-RUTHENSTEINER N.D. (NPI 1457472581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457472581 NPI number — DR. JENNIFER VALIA SCHIAVONE-RUTHENSTEINER N.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHIAVONE-RUTHENSTEINER
Provider First Name:
JENNIFER
Provider Middle Name:
VALIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
N.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RABINOVICH
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
VALIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457472581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 554
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREELAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98249-0554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-331-2464
Provider Business Mailing Address Fax Number:
866-277-7173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5548 MYRTLE AVE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
FREELAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98249-8776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-331-2464
Provider Business Practice Location Address Fax Number:
866-277-7173
Provider Enumeration Date:
04/03/2007

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: 175F00000X , with the licence number:  1312 , 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)





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