1861715310 NPI number — MISS CHELSEA LUNDSTROM CROSBY PA-C

Table of content: MISS CHELSEA LUNDSTROM CROSBY PA-C (NPI 1861715310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861715310 NPI number — MISS CHELSEA LUNDSTROM CROSBY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSBY
Provider First Name:
CHELSEA
Provider Middle Name:
LUNDSTROM
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
CHELSEA
Provider Other Middle Name:
LUNDSTROM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861715310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16233 SYLVESTER RD SW STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURIEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98166-3044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-835-7400
Provider Business Mailing Address Fax Number:
253-426-6344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16233 SYLVESTER RD SW STE 260
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-3044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-835-7400
Provider Business Practice Location Address Fax Number:
253-426-6344
Provider Enumeration Date:
03/11/2010

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: 363AM0700X , with the licence number:  PA.60135343 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA60135343 , 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: 0285886 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0285887 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2006147 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0261142 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com