1407035926 NPI number — CHRISTINE M. NICHOLSON, P.A.

Table of content: (NPI 1407035926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407035926 NPI number — CHRISTINE M. NICHOLSON, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTINE M. NICHOLSON, P.A.
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:
6
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:
1407035926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11205 NE 117TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98034-7031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-683-4845
Provider Business Mailing Address Fax Number:
425-285-0344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530B N 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEQUIM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98382-3079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-683-4845
Provider Business Practice Location Address Fax Number:
425-285-9344
Provider Enumeration Date:
11/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLSON
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-683-4845

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY00003423 , 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)

  • Identifier: 000N6325 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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