1538408935 NPI number — DESIREE BARCLIFT

Table of content: DESIREE BARCLIFT (NPI 1538408935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538408935 NPI number — DESIREE BARCLIFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARCLIFT
Provider First Name:
DESIREE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1538408935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820S MCCLELLAN ST 426
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99204-2446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-456-8444
Provider Business Mailing Address Fax Number:
509-455-9227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1090 W PARK PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-2785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-292-0705
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2013

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1107891 . This is a "NCCPA BOARD CERTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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