1104454743 NPI number — GINNETTE ERB DNP-FNP-C

Table of content: GINNETTE ERB DNP-FNP-C (NPI 1104454743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104454743 NPI number — GINNETTE ERB DNP-FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERB
Provider First Name:
GINNETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP-FNP-C
Provider Gender Code:
F

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:
1104454743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 CUNNINGHAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KELSO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98626-9482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-560-3883
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
804 ALLEN ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KELSO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98626-4456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-414-8818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2020

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: 163W00000X , with the licence number:  RN00137525 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP61178023 , 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: 123 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com