1487841623 NPI number — MRS. LETA KAYE EILERS MA00024665

Table of content: MRS. LETA KAYE EILERS MA00024665 (NPI 1487841623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487841623 NPI number — MRS. LETA KAYE EILERS MA00024665

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EILERS
Provider First Name:
LETA
Provider Middle Name:
KAYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA00024665
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:
1487841623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16431 SE 235TH ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-740-8373
Provider Business Mailing Address Fax Number:
253-631-7920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17039 SE 272ND ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-7348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-740-8373
Provider Business Practice Location Address Fax Number:
253-631-7920
Provider Enumeration Date:
10/02/2007

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: 225700000X , with the licence number:  MA00024665 , 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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