1477606002 NPI number — CHRISTI A VAN DEUSEN PT

Table of content: CHRISTI A VAN DEUSEN PT (NPI 1477606002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477606002 NPI number — CHRISTI A VAN DEUSEN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN DEUSEN
Provider First Name:
CHRISTI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1477606002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4031 DOUGLAS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97478-5588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-755-9195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 W BROADWAY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-3081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-206-2271
Provider Business Practice Location Address Fax Number:
541-470-8729
Provider Enumeration Date:
01/18/2007

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: 225100000X , with the licence number:  PT0007779 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 64426 , 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: P00126564 . This is a "RAILROAD MC#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: US2297155 . This is a "AETNA SPECIALIST PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: VA2194 . This is a "BLUE SHIELD #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8337354 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0039585 . This is a "LABOR AND INDUSTRIES#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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