1912042961 NPI number — WINDEE HARSTON LMP

Table of content: WINDEE HARSTON LMP (NPI 1912042961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912042961 NPI number — WINDEE HARSTON LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARSTON
Provider First Name:
WINDEE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMP
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:
1912042961
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:
12932 SE KENT KANGLEY RD
Provider Second Line Business Mailing Address:
#438
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98030-7940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-392-1814
Provider Business Mailing Address Fax Number:
425-392-1813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27116 167TH PL SE
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-7341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-630-6614
Provider Business Practice Location Address Fax Number:
253-630-6624
Provider Enumeration Date:
02/20/2007

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: 225700000X , with the licence number:  MA0018835 , 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: 32011135808 . This is a "UNIFORM MEDICAL INSURANCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0191035 . This is a "DEPT OF L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 331004230809 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7291730 . This is a "AETNA INSURANCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8381HA . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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