1720154834 NPI number — MS. ANNIE K WALL LMP, CFEP, APP

Table of content: MS. ANNIE K WALL LMP, CFEP, APP (NPI 1720154834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720154834 NPI number — MS. ANNIE K WALL LMP, CFEP, APP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALL
Provider First Name:
ANNIE
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMP, CFEP, APP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALL
Provider Other First Name:
ANNIE
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMP, CFEP, APP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720154834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29437 18TH AVENUE SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-817-2224
Provider Business Mailing Address Fax Number:
253-839-8634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 LAKE AVENUE SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-817-2224
Provider Business Practice Location Address Fax Number:
253-839-8634
Provider Enumeration Date:
11/28/2006

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: 174400000X , with the licence number:  MA7355 , 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)





Copyright © 2007-2024 www.npivalidator.com