1578663332 NPI number — PAULETTA J TOKICH ARNP, FNP

Table of content: PAULETTA J TOKICH ARNP, FNP (NPI 1578663332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578663332 NPI number — PAULETTA J TOKICH ARNP, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOKICH
Provider First Name:
PAULETTA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOKICH
Provider Other First Name:
POLLY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP, FNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578663332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 194
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COQUILLE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97423-0194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-329-0144
Provider Business Mailing Address Fax Number:
541-329-0142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 N CENTRAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COQUILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97423-1274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-329-0144
Provider Business Practice Location Address Fax Number:
541-329-0142
Provider Enumeration Date:
09/22/2006

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: 163W00000X , with the licence number:  200840133RN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP30007496 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 200850010NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1407812365 . This is a "NBMC GROUP NPI NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: R0000WFBTV . This is a "MEDICARE GROUP PIN NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 218436 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9652454 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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