1548592546 NPI number — MS. ZENDA RANAE HUBBARD LMP

Table of content: (NPI 1598859100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548592546 NPI number — MS. ZENDA RANAE HUBBARD LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBBARD
Provider First Name:
ZENDA
Provider Middle Name:
RANAE
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:
REIDT
Provider Other First Name:
ZENDA
Provider Other Middle Name:
RANAE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548592546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 817
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COULEE CITY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-632-8668
Provider Business Mailing Address Fax Number:
509-632-5761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 N ADAMS ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COULEE CITY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-632-8668
Provider Business Practice Location Address Fax Number:
509-632-5761
Provider Enumeration Date:
02/02/2010

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:  MA60115273 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2471C3402X , with the licence number: CX60238750 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CX60238750 . This is a "STATE OF WASHINGTON" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".