1861500332 NPI number — MAUREEN L. MASTERSON

Table of content: MAUREEN L. MASTERSON (NPI 1861500332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861500332 NPI number — MAUREEN L. MASTERSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASTERSON
Provider First Name:
MAUREEN
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOODS
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861500332
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 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COUPEVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98239-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-682-4059
Provider Business Mailing Address Fax Number:
360-678-3636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 NE MIDWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98277-2642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-682-4059
Provider Business Practice Location Address Fax Number:
360-678-3636
Provider Enumeration Date:
08/26/2006

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: 101YM0800X , with the licence number:  RC00017962 , 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: RC00017962 . This is a "COUNSELOR REGISTRATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com