1235688268 NPI number — NICOLE ANDREA HECKENLAIBLE DENTAL HYGIENE

Table of content: NICOLE ANDREA HECKENLAIBLE DENTAL HYGIENE (NPI 1235688268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235688268 NPI number — NICOLE ANDREA HECKENLAIBLE DENTAL HYGIENE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HECKENLAIBLE
Provider First Name:
NICOLE
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DENTAL HYGIENE
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:
1235688268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PUSH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98350
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:
560 QUILEUTE HEIGHTS
Provider Second Line Business Practice Location Address:
QUILEUTE HEALTH CENTER
Provider Business Practice Location Address City Name:
LA PUSH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-374-6984
Provider Business Practice Location Address Fax Number:
360-374-9049
Provider Enumeration Date:
10/03/2016

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: 124Q00000X , with the licence number:  DH00007007 , 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)





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