1710355391 NPI number — PAUL BLANCHARD BA CADC CANDIDATE

Table of content: PAUL BLANCHARD BA CADC CANDIDATE (NPI 1710355391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710355391 NPI number — PAUL BLANCHARD BA CADC CANDIDATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANCHARD
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA CADC CANDIDATE
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLANCHARD
Provider Other First Name:
PAUL
Provider Other Middle Name:
CHARLES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710355391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16063 BONAIRE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97035-4149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-799-8218
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16063 BONAIRE AVE
Provider Second Line Business Practice Location Address:
000
Provider Business Practice Location Address City Name:
LAKE OSWEGO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97035-4149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-799-8218
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2015

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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