1104156934 NPI number — MARGARET J SMITH B.S,R.C.,C.D.P.

Table of content: MARGARET J SMITH B.S,R.C.,C.D.P. (NPI 1104156934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104156934 NPI number — MARGARET J SMITH B.S,R.C.,C.D.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MARGARET
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.S,R.C.,C.D.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUCHER
Provider Other First Name:
MARGARET
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104156934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34703
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-1703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-764-0112
Provider Business Mailing Address Fax Number:
206-764-0489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19707 44TH AVE W
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-6757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-977-2560
Provider Business Practice Location Address Fax Number:
425-977-2561
Provider Enumeration Date:
12/29/2009

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: 101YA0400X , with the licence number:  CP00001902 , 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)





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