1336610211 NPI number — MRS. REBECCA KUSCHE IBCLC

Table of content: MRS. REBECCA KUSCHE IBCLC (NPI 1336610211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336610211 NPI number — MRS. REBECCA KUSCHE IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUSCHE
Provider First Name:
REBECCA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
IBCLC
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:
1336610211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8415 SE WILLOCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLALLA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98359-9666
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:
8415 SE WILLOCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98359-9666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-550-2607
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2018

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: 133NN1002X , with the licence number:  NU60418972 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174N00000X , with the licence number: L-23776 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: L-23776 . This is a "IBCLE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: NU60418972 . This is a "NUTRITIONIST CERTIFICATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".