1154497907 NPI number — MS. HOLLY NOELLE HEIAN L.M.P.

Table of content: MS. HOLLY NOELLE HEIAN L.M.P. (NPI 1154497907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154497907 NPI number — MS. HOLLY NOELLE HEIAN L.M.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIAN
Provider First Name:
HOLLY
Provider Middle Name:
NOELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.P.
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:
1154497907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6334 LITTLEROCK RD SW
Provider Second Line Business Mailing Address:
BLDG 6, SUITE 101
Provider Business Mailing Address City Name:
TUMWATER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-359-2162
Provider Business Mailing Address Fax Number:
360-709-9220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6334 LITTLEROCK RD SW
Provider Second Line Business Practice Location Address:
BLDG 6, SUITE 101
Provider Business Practice Location Address City Name:
TUMWATER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-359-2162
Provider Business Practice Location Address Fax Number:
360-709-9220
Provider Enumeration Date:
11/24/2006

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: 225700000X , with the licence number:  MA17411 , 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: MA17411 . This is a "HEALTH LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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