1780943779 NPI number — MRS. NATALLIE JOY VANDYKE BA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780943779 NPI number — MRS. NATALLIE JOY VANDYKE BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDYKE
Provider First Name:
NATALLIE
Provider Middle Name:
JOY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOBZIEN
Provider Other First Name:
NATALLIE
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780943779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2023
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:
97051-8234
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:
271 COLUMBIA BLVD
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:
97051-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-397-0391
Provider Business Practice Location Address Fax Number:
503-366-1067
Provider Enumeration Date:
05/10/2012

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: 171M00000X , 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)

  • Identifier: 12390 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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