1134200041 NPI number — MS. KAREN CORLETT CPNP

Table of content: MS. KAREN CORLETT CPNP (NPI 1134200041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134200041 NPI number — MS. KAREN CORLETT CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORLETT
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP
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:
1134200041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 SAND POINT WAY NE
Provider Second Line Business Mailing Address:
FA. 2. 300A, SEATTLE CHILDREN'S HOSPITAL
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98145-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-987-2000
Provider Business Mailing Address Fax Number:
866-771-0383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 SAND POINT WAY NE
Provider Second Line Business Practice Location Address:
FA. 2. 300A, SEATTLE CHILDREN'S HOSPITAL
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98145-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-987-2000
Provider Business Practice Location Address Fax Number:
866-771-0383
Provider Enumeration Date:
10/18/2006

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: 363LP0200X , with the licence number:  701304 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00802219 . This is a "RR MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2101586-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".