1316322597 NPI number — MRS. CARRIE LOVEMARK L.AC.

Table of content: ALBERT YT WU MD (NPI 1053721696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316322597 NPI number — MRS. CARRIE LOVEMARK L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVEMARK
Provider First Name:
CARRIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.AC.
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:
1316322597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYS CREEK
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-517-9869
Provider Business Mailing Address Fax Number:
541-543-2220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 S. OLD PACIFIC HWY, SUITE #100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE CREEK
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-860-1515
Provider Business Practice Location Address Fax Number:
541-543-2220
Provider Enumeration Date:
07/29/2015

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: 171100000X , with the licence number:  172295 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: AC172295 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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