1417491598 NPI number — MS. KATHARINE WARFIELD YEATON CADC 1, CRM

Table of content: MS. KATHARINE WARFIELD YEATON CADC 1, CRM (NPI 1417491598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417491598 NPI number — MS. KATHARINE WARFIELD YEATON CADC 1, CRM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEATON
Provider First Name:
KATHARINE
Provider Middle Name:
WARFIELD
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CADC 1, CRM
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:
1417491598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7814 N FOWLER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97217-5933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-791-9603
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22018 S CENTRAL POINT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANBY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97013-8705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-791-9603
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2016

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: 106S00000X , 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: 106S00000X . This is a "UNKNOWN DESIGNATION" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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