1285872283 NPI number — MRS. MOLLY GENEVIEVE BREITMUN LMP

Table of content: MRS. MOLLY GENEVIEVE BREITMUN LMP (NPI 1285872283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285872283 NPI number — MRS. MOLLY GENEVIEVE BREITMUN LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREITMUN
Provider First Name:
MOLLY
Provider Middle Name:
GENEVIEVE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARVEY
Provider Other First Name:
MOLLY
Provider Other Middle Name:
GENEVIEVE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285872283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2625 B PARKMONT LN SW
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98502-5751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-943-2940
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2625 B PARKMONT LN SW
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98502-5751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-943-2940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2009

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:  MA60066736 , 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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