1902861057 NPI number — MRS. ANGELA CHRISTINE YOUNGGREN MS LAC

Table of content: MRS. ANGELA CHRISTINE YOUNGGREN MS LAC (NPI 1902861057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902861057 NPI number — MRS. ANGELA CHRISTINE YOUNGGREN MS LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNGGREN
Provider First Name:
ANGELA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902861057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 58009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98058-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-235-4181
Provider Business Mailing Address Fax Number:
425-277-3785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19110 BOTHELL WAY NE
Provider Second Line Business Practice Location Address:
#103
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98011-2970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-424-3588
Provider Business Practice Location Address Fax Number:
425-424-0818
Provider Enumeration Date:
04/20/2006

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: 171100000X , with the licence number:  AC527 , 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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