1750340337 NPI number — MRS. JODIE L PASCHALL-MAJERUS PT

Table of content: MRS. JODIE L PASCHALL-MAJERUS PT (NPI 1750340337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750340337 NPI number — MRS. JODIE L PASCHALL-MAJERUS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASCHALL-MAJERUS
Provider First Name:
JODIE
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1750340337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16219 SE 12TH ST
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683-8904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-253-4020
Provider Business Mailing Address Fax Number:
360-604-9293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16219 SE 12TH ST
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98683-8904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-253-4020
Provider Business Practice Location Address Fax Number:
360-604-9293
Provider Enumeration Date:
03/21/2006

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: 225100000X , with the licence number:  2500 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 7571 , 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: 7106966 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com