1568134120 NPI number — ELAINE REDNER

Table of content: ELAINE REDNER (NPI 1568134120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568134120 NPI number — ELAINE REDNER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDNER
Provider First Name:
ELAINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1568134120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10132 NE 185TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98011-3434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-486-4040
Provider Business Mailing Address Fax Number:
509-325-7666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 N CENTER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-486-4040
Provider Business Practice Location Address Fax Number:
509-325-7666
Provider Enumeration Date:
10/01/2021

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: 163WR0400X , with the licence number:  RN0012255 , 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)

  • Identifier: 095000382RN . This is a "OREGON BOARD OF NURSING" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 26NR19617500 . This is a "NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: RN0012255 . This is a "WASHINGTON STATE BOARD OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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