1669705760 NPI number — DR. VICTORIA ANNE RADABAUGH PH.D.

Table of content: DR. VICTORIA ANNE RADABAUGH PH.D. (NPI 1669705760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669705760 NPI number — DR. VICTORIA ANNE RADABAUGH PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADABAUGH
Provider First Name:
VICTORIA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCKEEVER
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669705760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16770 NE 79TH ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98052-4413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-550-8241
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16770 NE 79TH ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98052-4413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-550-8241
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2009

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: 103TC1900X , with the licence number:  PY00002981 , 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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