1104156827 NPI number — MRS. CARRIE MICHAEL SPAGNUOLA M.S.

Table of content: MRS. CARRIE MICHAEL SPAGNUOLA M.S. (NPI 1104156827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104156827 NPI number — MRS. CARRIE MICHAEL SPAGNUOLA M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPAGNUOLA
Provider First Name:
CARRIE
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCARAMASTRA
Provider Other First Name:
CARRIE
Provider Other Middle Name:
MICHAEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104156827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6926 NE FOURTH PLAIN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98661-7254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6926 NE FOURTH PLAIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98661-7254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-993-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2009

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: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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