1487885638 NPI number — MRS. JODI AUGUSTINE RD, CD

Table of content: MRS. JODI AUGUSTINE RD, CD (NPI 1487885638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487885638 NPI number — MRS. JODI AUGUSTINE RD, CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUGUSTINE
Provider First Name:
JODI
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRAMPTON
Provider Other First Name:
JODI
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, CD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487885638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 FAIRVIEW AVE E
Provider Second Line Business Mailing Address:
STE 205
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98102-3727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-890-6901
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 16TH AVE E
Provider Second Line Business Practice Location Address:
A018
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-5211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-326-3451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2009

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: 133V00000X , with the licence number:  985208 , 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: DI60076272 . This is a "WA DOH CERTIFICATION NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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