1649429317 NPI number — MS. ELIZABETH MARIE ALLEN-RACICOT L.M.P.

Table of content: MS. ELIZABETH MARIE ALLEN-RACICOT L.M.P. (NPI 1649429317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649429317 NPI number — MS. ELIZABETH MARIE ALLEN-RACICOT L.M.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN-RACICOT
Provider First Name:
ELIZABETH
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLEN
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649429317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
731 BURNELL AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83501-4985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-798-3215
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 BRIDGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-751-9377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2008

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: 174400000X , with the licence number:  MA00022912 , 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)