1326374489 NPI number — MRS. JEMIMA VALENZUELA CROSSFIELD LMP

Table of content: MRS. JEMIMA VALENZUELA CROSSFIELD LMP (NPI 1326374489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326374489 NPI number — MRS. JEMIMA VALENZUELA CROSSFIELD LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSSFIELD
Provider First Name:
JEMIMA
Provider Middle Name:
VALENZUELA
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:
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:
1326374489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 661
Provider Second Line Business Mailing Address:
190 9TH STREET
Provider Business Mailing Address City Name:
POMEROY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99347-0661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-843-3830
Provider Business Mailing Address Fax Number:
509-843-3830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 9TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMEROY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99347-0661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-843-3830
Provider Business Practice Location Address Fax Number:
509-843-3830
Provider Enumeration Date:
10/26/2009

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:  MA 00012838 , 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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