1710318522 NPI number — DAVID LEFEVRE, OD, PLLC

Table of content: ELIZABETH ADELEYE MSN, FNP, BC. (NPI 1144683921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710318522 NPI number — DAVID LEFEVRE, OD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID LEFEVRE, OD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1710318522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1570 WILMINGTON DR
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
DUPONT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98327-8773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-912-0900
Provider Business Mailing Address Fax Number:
253-912-8080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1570 WILMINGTON DR
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
DUPONT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98327-8773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-912-0900
Provider Business Practice Location Address Fax Number:
253-912-8080
Provider Enumeration Date:
12/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LEFEVRE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
253-912-0900

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  1555 , 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: 1124183264 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".




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