1518324011 NPI number — MARIA LYNN ULERY-LAFRINIERE CADC II

Table of content: MARIA LYNN ULERY-LAFRINIERE CADC II (NPI 1518324011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518324011 NPI number — MARIA LYNN ULERY-LAFRINIERE CADC II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULERY-LAFRINIERE
Provider First Name:
MARIA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CADC II
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAFRINIERE
Provider Other First Name:
MARIA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CADC I
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518324011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1869 SKYLINE CTS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-437-5843
Provider Business Mailing Address Fax Number:
503-879-4606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 PRICE RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97322-7314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-928-9681
Provider Business Practice Location Address Fax Number:
541-928-5990
Provider Enumeration Date:
01/28/2016

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: 174400000X , with the licence number:  15-06-09 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 18-02-24 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 18-02-04 , 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)