1649868126 NPI number — MR. FRANK CHARLES BASHUMIKA MPH, APRN

Table of content: MR. FRANK CHARLES BASHUMIKA MPH, APRN (NPI 1649868126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649868126 NPI number — MR. FRANK CHARLES BASHUMIKA MPH, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASHUMIKA
Provider First Name:
FRANK
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MPH, APRN
Provider Gender Code:
M

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:
1649868126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15127 MAIN STREET E SUITE 104
Provider Second Line Business Mailing Address:
PMB 231
Provider Business Mailing Address City Name:
SUMNER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98390-6901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-988-0798
Provider Business Mailing Address Fax Number:
206-673-8050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 112TH AVE SE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-6901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-615-8930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2021

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: 363LP0808X , with the licence number:  AP61135663 , 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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