1669870549 NPI number — MS. RONELLE LEE HOLZNAGEL CADC I, QMHA

Table of content: MS. RONELLE LEE HOLZNAGEL CADC I, QMHA (NPI 1669870549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669870549 NPI number — MS. RONELLE LEE HOLZNAGEL CADC I, QMHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLZNAGEL
Provider First Name:
RONELLE
Provider Middle Name:
LEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CADC I, QMHA
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:
1669870549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT HELENS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-397-5211
Provider Business Mailing Address Fax Number:
503-397-5373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58646 MCNULTY WAY BLDG 17
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT HELENS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97051-6210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-438-2244
Provider Business Practice Location Address Fax Number:
360-397-8494
Provider Enumeration Date:
12/09/2014

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: 101YA0400X , with the licence number:  CO60435470 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 16-04-11 , 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)





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