1689406175 NPI number — MRS. SIENA TREASE DICKINSON MA61578997

Table of content: MRS. SIENA TREASE DICKINSON MA61578997 (NPI 1689406175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689406175 NPI number — MRS. SIENA TREASE DICKINSON MA61578997

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKINSON
Provider First Name:
SIENA
Provider Middle Name:
TREASE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA61578997
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYNOLDS
Provider Other First Name:
SIENA
Provider Other Middle Name:
TREASE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689406175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3708 HOME RD UNIT 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-1012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-500-6739
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2216 CORNWALL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-3719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-650-1040
Provider Business Practice Location Address Fax Number:
360-647-1542
Provider Enumeration Date:
08/14/2024

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: 225700000X , with the licence number:  MA61578997 , 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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