1043348006 NPI number — EVA FAYE DEE HIATT

Table of content: (NPI 1043348006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043348006 NPI number — EVA FAYE DEE HIATT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVA FAYE DEE HIATT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1043348006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16720 SE 271ST ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98042-7342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-631-2380
Provider Business Mailing Address Fax Number:
425-649-2057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4957 LAKEMONT BLVD
Provider Second Line Business Practice Location Address:
SUITE C-4 BOX #202
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-746-7068
Provider Business Practice Location Address Fax Number:
425-649-2057
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HIATT
Authorized Official First Name:
EVA FAYE
Authorized Official Middle Name:
DEE
Authorized Official Title or Position:
OWNER PRACTIONER
Authorized Official Telephone Number:
253-631-2380

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  AP30004647 , 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: 0001133372 . This is a "MHN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 156388100000 . This is a "PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: A944372 . This is a "UPS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 00076444478 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9472HI . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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