1497974992 NPI number — MS. CYNTHIA L GILLICK L.M.P.

Table of content: MS. CYNTHIA L GILLICK L.M.P. (NPI 1497974992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497974992 NPI number — MS. CYNTHIA L GILLICK L.M.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLICK
Provider First Name:
CYNTHIA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.P.
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:
1497974992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9341 NIKA TRL NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-9304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-649-8426
Provider Business Mailing Address Fax Number:
206-666-3739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6611 KITSAP WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98312-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-377-8770
Provider Business Practice Location Address Fax Number:
206-666-3739
Provider Enumeration Date:
04/24/2007

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:  MA00019965 , 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: 0201438 . This is a "DEPT OF LABOR & INDUSTRIE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8925559 . This is a "CRIME VICTIMS COMP PROGRA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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