1235485731 NPI number — LORA C BIRD ANP-C

Table of content: LORA C BIRD ANP-C (NPI 1235485731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235485731 NPI number — LORA C BIRD ANP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRD
Provider First Name:
LORA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP-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:
1235485731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5990 WILLOWBEND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99353-6079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-753-0687
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 GAGE BLVD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-9716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-753-0687
Provider Business Practice Location Address Fax Number:
509-942-3273
Provider Enumeration Date:
08/02/2012

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: 363LA2200X , with the licence number:  18180 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: AP60519194 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP60519194 , 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: 96187 . This is a "RN LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 202005260NP-PP . This is a "OREGON BOARD OF NURSING" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1235485731 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18180 . This is a "TN BOARD OF NURSING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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