1982851416 NPI number — MRS. MIRANDA HEATHER RICHINS

Table of content: MRS. MIRANDA HEATHER RICHINS (NPI 1982851416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982851416 NPI number — MRS. MIRANDA HEATHER RICHINS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHINS
Provider First Name:
MIRANDA
Provider Middle Name:
HEATHER
Provider Name Prefix Text:
MRS.
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:
COLLINS
Provider Other First Name:
MIRANDA
Provider Other Middle Name:
HEATHER
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982851416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
324 NE AUTUMN ROSE WAY APT F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97124-5312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-801-5183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4855 SW WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97005-3460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-643-7565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2008

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: 246RP1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)