1780809756 NPI number — MRS. SHEILA BLAKE KING LMP

Table of content: MRS. SHEILA BLAKE KING LMP (NPI 1780809756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780809756 NPI number — MRS. SHEILA BLAKE KING LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
SHEILA
Provider Middle Name:
BLAKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KING
Provider Other First Name:
SHEILA
Provider Other Middle Name:
KAYE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780809756
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:
PO BOX 174
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACME
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98220-0174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-927-2727
Provider Business Mailing Address Fax Number:
360-595-2274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 N COMMERCIAL ST
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-4446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-927-2727
Provider Business Practice Location Address Fax Number:
360-595-2274
Provider Enumeration Date:
04/16/2007

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: 225700000X , with the licence number:  MA00019927 , 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)