1164716304 NPI number — KATE B JABLONSKI

Table of content: KATE B JABLONSKI (NPI 1164716304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164716304 NPI number — KATE B JABLONSKI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JABLONSKI
Provider First Name:
KATE
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIDTFELDT
Provider Other First Name:
KATE
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164716304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 CHESHIRE PKWY N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55446-4103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-268-4388
Provider Business Mailing Address Fax Number:
763-268-4017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1038 116TH AVE NE
Provider Second Line Business Practice Location Address:
STE 330
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-4621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-455-5596
Provider Business Practice Location Address Fax Number:
425-451-3248
Provider Enumeration Date:
06/06/2011

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: 231H00000X , with the licence number:  LD60003462 , 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)