1417008384 NPI number — THERESA SEWELL WINFIELD ARNP

Table of content: THERESA SEWELL WINFIELD ARNP (NPI 1417008384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417008384 NPI number — THERESA SEWELL WINFIELD ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINFIELD
Provider First Name:
THERESA
Provider Middle Name:
SEWELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HICKS
Provider Other First Name:
THERESA
Provider Other Middle Name:
WINFIELD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417008384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1123 POMONA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98901-9353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-469-6823
Provider Business Mailing Address Fax Number:
509-241-1841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1123 POMONA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98901-9353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-469-6823
Provider Business Practice Location Address Fax Number:
509-241-1841
Provider Enumeration Date:
01/16/2007

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: 163WP0809X , with the licence number:  RN00045172 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP30004371 , 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: 11629906 . This is a "CAQH ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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