1558738641 NPI number — CAROL ELLEN WILSON RN, MSN

Table of content: CAROL ELLEN WILSON RN, MSN (NPI 1558738641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558738641 NPI number — CAROL ELLEN WILSON RN, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
CAROL
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN
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:
1558738641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
713 THRASHER AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BEND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98045-7919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-888-0110
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOQUIAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98550-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-236-5328
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2015

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: 163WP0808X , with the licence number:  RN00086590 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN00086590 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: RN00086590 , 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: WAC 3888650150 . This is a "MENTAL HEALTH PROFESSIONAL BY MENTAL HEALTH DIVISION OF WA STATE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0216286 . This is a "NATIONAL CERTIFICATION IN PSYCHIATRIC AND MENTAL HEALTH NURSING" identifier . This identifiers is of the category "OTHER".
  • Identifier: RN00086590 . This is a "RN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com