1982999868 NPI number — ROSHANA DEE GRILE STUDENT INTERN

Table of content: ROSHANA DEE GRILE STUDENT INTERN (NPI 1982999868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982999868 NPI number — ROSHANA DEE GRILE STUDENT INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRILE
Provider First Name:
ROSHANA
Provider Middle Name:
DEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
STUDENT INTERN
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:
1982999868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 E 2ND ST
Provider Second Line Business Mailing Address:
SUITE 155
Provider Business Mailing Address City Name:
NEWBERG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97132-3076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-756-7390
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 E 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
NEWBERG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97132-3076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-756-7390
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2011

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: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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