1528801875 NPI number — MRS. CHRISTINA MARIE FLESCH CADC1

Table of content: MRS. CHRISTINA MARIE FLESCH CADC1 (NPI 1528801875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528801875 NPI number — MRS. CHRISTINA MARIE FLESCH CADC1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLESCH
Provider First Name:
CHRISTINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CADC1
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARDSON
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CADC-R
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528801875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 NW 5TH ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORVALLIS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97330-4849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-286-4010
Provider Business Mailing Address Fax Number:
541-286-4011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 NW 5TH ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97330-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-286-4010
Provider Business Practice Location Address Fax Number:
541-286-4011
Provider Enumeration Date:
06/14/2024

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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