1780630640 NPI number — MS. BARBARA JEAN SEVERSON ARNP

Table of content: MS. BARBARA JEAN SEVERSON ARNP (NPI 1780630640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780630640 NPI number — MS. BARBARA JEAN SEVERSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEVERSON
Provider First Name:
BARBARA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEVERSON
Provider Other First Name:
BOBBIE
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780630640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12040 NE 128TH ST
Provider Second Line Business Mailing Address:
MS-10
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98034-3013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-899-3270
Provider Business Mailing Address Fax Number:
425-899-3269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12333 NE 130TH LN
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-7467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-899-5350
Provider Business Practice Location Address Fax Number:
425-899-5355
Provider Enumeration Date:
05/25/2006

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: 363LA2200X , with the licence number:  AP30004455 , 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: 1233SE . This is a "BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: NP3100W , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9621350 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213265 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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