1689739419 NPI number — DEBRA A BAXTER RDH

Table of content: DEBRA A BAXTER RDH (NPI 1689739419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689739419 NPI number — DEBRA A BAXTER RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAXTER
Provider First Name:
DEBRA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLIFTON
Provider Other First Name:
DEBRA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RCH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689739419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 593
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLYN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98524-0593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-275-4069
Provider Business Mailing Address Fax Number:
360-275-4069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 E COULTER CREEK RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELFAIR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-275-4069
Provider Business Practice Location Address Fax Number:
360-275-4069
Provider Enumeration Date:
12/22/2006

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: 124Q00000X , with the licence number:  DH00004553 , 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)

  • Identifier: 5900980 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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