1043529985 NPI number — MRS. CHRISTINA MICHELLE JANDER PA-C

Table of content: MRS. CHRISTINA MICHELLE JANDER PA-C (NPI 1043529985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043529985 NPI number — MRS. CHRISTINA MICHELLE JANDER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANDER
Provider First Name:
CHRISTINA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAPMAN
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043529985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 16TH AVENUE EAST
Provider Second Line Business Mailing Address:
CAPITOL HILL MAIN BUILDING
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98112-5260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-326-3000
Provider Business Mailing Address Fax Number:
206-326-2785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4011 TALBOT RD S
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98055-5773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-656-5060
Provider Business Practice Location Address Fax Number:
425-656-5047
Provider Enumeration Date:
09/27/2010

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: 363A00000X , with the licence number:  PA60178763 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X , with the licence number: PA60178763 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0289787 . This is a "LNI POA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P01037373 . This is a "MEDICARE RR POA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8895131 . This is a "MEDICARE PTAN NWSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 270410 . This is a "L & I NWSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8906345 . This is a "MEDICARE PTAN POA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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