1497871149 NPI number — MRS. WENDY ANN WOLTHAUSEN LMP

Table of content: MRS. WENDY ANN WOLTHAUSEN LMP (NPI 1497871149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497871149 NPI number — MRS. WENDY ANN WOLTHAUSEN LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLTHAUSEN
Provider First Name:
WENDY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
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:
1497871149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 652
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE STEVENS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98258-0652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-359-8338
Provider Business Mailing Address Fax Number:
425-334-5041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9623 32ND ST SE
Provider Second Line Business Practice Location Address:
HWY 9 OFFICE PARK BLDG D - SUITE 113
Provider Business Practice Location Address City Name:
LAKE STEVENS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98258-5779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-359-8338
Provider Business Practice Location Address Fax Number:
425-334-5041
Provider Enumeration Date:
03/22/2007

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: 225700000X , with the licence number:  MA00016916 , 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)