1851720916 NPI number — MRS. JESSICA ANNE WEATHERSEED L.M.P.

Table of content: CELIA TEJEDA (NPI 1881133536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851720916 NPI number — MRS. JESSICA ANNE WEATHERSEED L.M.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEATHERSEED
Provider First Name:
JESSICA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUTT
Provider Other First Name:
JESSICA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851720916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12302 219TH AVE. CT.E.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONNEY LAKE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-405-9803
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22015 STATE ROUTE 410 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-891-9109
Provider Business Practice Location Address Fax Number:
253-826-0438
Provider Enumeration Date:
11/08/2013

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: 172M00000X , with the licence number:  MA60329055 , 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)





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