1720150105 NPI number — MS. CATHERINE ANNE DELSECCO PA-C

Table of content: MS. CATHERINE ANNE DELSECCO PA-C (NPI 1720150105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720150105 NPI number — MS. CATHERINE ANNE DELSECCO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELSECCO
Provider First Name:
CATHERINE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1720150105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8435 SE 68TH ST
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
MERCER ISLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98040-5249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-232-7546
Provider Business Mailing Address Fax Number:
206-275-0805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8435 SE 68TH ST
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
MERCER ISLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98040-5249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-232-7546
Provider Business Practice Location Address Fax Number:
206-275-0805
Provider Enumeration Date:
11/14/2006

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: 207P00000X , with the licence number:  PA10004561 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA-10004561 , 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: P00274267 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: US7872525 . This is a "AETNA SPECIALIST PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8371676 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0039578 . This is a "LABOR AND INDUSTRIES #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3743DE . This is a "BLUE SHIELD #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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