1598247207 NPI number — MISS KRISTINE MARIE MCGINLEY LAC

Table of content: MISS KRISTINE MARIE MCGINLEY LAC (NPI 1598247207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598247207 NPI number — MISS KRISTINE MARIE MCGINLEY LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGINLEY
Provider First Name:
KRISTINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LAC
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:
1598247207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 EAST 33RD ST.
Provider Second Line Business Mailing Address:
STE 203A
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-258-0587
Provider Business Mailing Address Fax Number:
360-253-3961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 EAST 33RD ST.
Provider Second Line Business Practice Location Address:
STE 203A
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-258-0587
Provider Business Practice Location Address Fax Number:
360-253-3961
Provider Enumeration Date:
08/30/2018

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: 171100000X , with the licence number:  AC60700591 , 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)





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