1538407747 NPI number — MADDIE RAE FRANCO MADDIE FRANCO

Table of content: MADDIE RAE FRANCO MADDIE FRANCO (NPI 1538407747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538407747 NPI number — MADDIE RAE FRANCO MADDIE FRANCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANCO
Provider First Name:
MADDIE
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MADDIE FRANCO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRANCO
Provider Other First Name:
MADELINE
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MADDIE FRANCO
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1538407747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4028 S PINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98409-5612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-225-6221
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4028 S PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409-5612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-225-6221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2013

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:  60315754 , 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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