1629320874 NPI number — VIRGINIA SMITH-DUNWOODY DNP, NP

Table of content: VIRGINIA SMITH-DUNWOODY DNP, NP (NPI 1629320874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629320874 NPI number — VIRGINIA SMITH-DUNWOODY DNP, NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH-DUNWOODY
Provider First Name:
VIRGINIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP, NP
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:
1629320874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 GAGE BLVD
Provider Second Line Business Mailing Address:
STE 203
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-942-3627
Provider Business Mailing Address Fax Number:
509-942-2268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4804 W CLEARWATER AVENUE
Provider Second Line Business Practice Location Address:
KADLEC CLINIC URGENT CARE
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-942-2355
Provider Business Practice Location Address Fax Number:
509-222-1289
Provider Enumeration Date:
10/12/2012

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: 363LF0000X , with the licence number:  CNP121087 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP60309079 , 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: 162932087 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CNP121087 . This is a "LICENSE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".