1003020850 NPI number — MRS. JOELLE MARIE BENOIT BREKHUS LMP

Table of content: MRS. JOELLE MARIE BENOIT BREKHUS LMP (NPI 1003020850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003020850 NPI number — MRS. JOELLE MARIE BENOIT BREKHUS LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENOIT BREKHUS
Provider First Name:
JOELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
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:
BENOIT
Provider Other First Name:
JOELLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003020850
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:
519 1ST AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EPHRATA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98823-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-754-6387
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1519 BASIN ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98823-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-2461
Provider Business Practice Location Address Fax Number:
509-754-2462
Provider Enumeration Date:
05/10/2007

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:  MA00019749 , 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: 0190967 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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