1629519152 NPI number — KATHYH HARVEY MS RDN CSR

Table of content: KATHYH HARVEY MS RDN CSR (NPI 1629519152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629519152 NPI number — KATHYH HARVEY MS RDN CSR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARVEY
Provider First Name:
KATHYH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS RDN CSR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARVEY
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
SCHIRO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS RDN CSR
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1629519152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21309 44TH AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTLAKE TERRACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98043-3507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-744-1095
Provider Business Mailing Address Fax Number:
425-775-1144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21309 44TH AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-744-1095
Provider Business Practice Location Address Fax Number:
425-775-1144
Provider Enumeration Date:
03/16/2017

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: 133VN1005X , with the licence number:  DI00001384 , 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: 8295750 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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