1225518657 NPI number — MS. JORDAN RYLEE CHIEROTTI CB60887865

Table of content: MS. JORDAN RYLEE CHIEROTTI CB60887865 (NPI 1225518657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225518657 NPI number — MS. JORDAN RYLEE CHIEROTTI CB60887865

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIEROTTI
Provider First Name:
JORDAN
Provider Middle Name:
RYLEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CB60887865
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHIEROTTI
Provider Other First Name:
JAY
Provider Other Middle Name:
RYLEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225518657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4238 AUBURN WAY N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98002-1311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4238 AUBURN WAY N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-876-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2018

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: 106E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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