1356784144 NPI number — ALYSSA JOANN COLBY IBCLC, CHW

Table of content: ALYSSA JOANN COLBY IBCLC, CHW (NPI 1356784144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356784144 NPI number — ALYSSA JOANN COLBY IBCLC, CHW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLBY
Provider First Name:
ALYSSA
Provider Middle Name:
JOANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IBCLC, CHW
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:
1356784144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
591 NE 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINEVILLE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97754-2014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-280-3031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 NW BEAVER ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINEVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97754-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-447-5165
Provider Business Practice Location Address Fax Number:
541-447-3093
Provider Enumeration Date:
04/10/2013

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: 176B00000X , with the licence number:  DEM-LD-10154656 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172V00000X , 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)

  • Identifier: DEM-LD-10154656 . This is a "MIDWIFERY LICENSE NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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