1447684121 NPI number — MS. DEBBIE JEAN MERA LMP

Table of content: MS. DEBBIE JEAN MERA LMP (NPI 1447684121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447684121 NPI number — MS. DEBBIE JEAN MERA LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERA
Provider First Name:
DEBBIE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMP
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:
1447684121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 891
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUSH PRAIRIE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-907-0627
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
819 SW 14TH LOOP
Provider Second Line Business Practice Location Address:
SUITE 101C
Provider Business Practice Location Address City Name:
BATTLE GROUND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98604-9860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-907-0627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2013

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: 172M00000X , with the licence number:  MA00020378 , 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: 1447684121 . This is a "WA STATE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com