1417209040 NPI number — MR. DAVID ELLIS HENSLEY CPO, FAAOP

Table of content: MR. DAVID ELLIS HENSLEY CPO, FAAOP (NPI 1417209040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417209040 NPI number — MR. DAVID ELLIS HENSLEY CPO, FAAOP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSLEY
Provider First Name:
DAVID
Provider Middle Name:
ELLIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CPO, FAAOP
Provider Gender Code:
M

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:
1417209040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6405 218TH ST SW STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTLAKE TERRACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98043-2180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-640-2004
Provider Business Mailing Address Fax Number:
206-299-9445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 14TH AVE SE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98372-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-848-2888
Provider Business Practice Location Address Fax Number:
206-299-9445
Provider Enumeration Date:
10/05/2012

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: 222Z00000X , with the licence number:  OI00000072 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X , with the licence number: PS00000071 , 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)





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