1518921154 NPI number — MRS. STACIE C SCHREIBEIS P.T.A., A.T.C.

Table of content: MRS. STACIE C SCHREIBEIS P.T.A., A.T.C. (NPI 1518921154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518921154 NPI number — MRS. STACIE C SCHREIBEIS P.T.A., A.T.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHREIBEIS
Provider First Name:
STACIE
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.A., A.T.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VISSER
Provider Other First Name:
STACIE
Provider Other Middle Name:
C.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518921154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11915 E BROADWAY AVE
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99206-4997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-228-9404
Provider Business Mailing Address Fax Number:
509-228-9403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11915 E BROADWAY AVE
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-4997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-228-9404
Provider Business Practice Location Address Fax Number:
509-228-9403
Provider Enumeration Date:
04/12/2006

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: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: P160045502 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225200000X , with the licence number: PTA-2497 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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