1396381653 NPI number — MEGHAN DEVONPORT, LMP

Table of content: DR. ERIK SAMUEL RUBINSON M.D. (NPI 1750397394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396381653 NPI number — MEGHAN DEVONPORT, LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEGHAN DEVONPORT, LMP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1396381653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3318 159TH LN SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98087-1545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-843-5935
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1417 NW 54TH ST STE 455
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-3564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-843-5935
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DEVONPORT
Authorized Official First Name:
MEGHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MASSAGE THERAPIST/BUSINESS OWNER
Authorized Official Telephone Number:
561-843-5935

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1962651976 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com