1770353872 NPI number — CASHMERE QUINN BRADBURY BA, SUDPT

Table of content: CASHMERE QUINN BRADBURY BA, SUDPT (NPI 1770353872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770353872 NPI number — CASHMERE QUINN BRADBURY BA, SUDPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADBURY
Provider First Name:
CASHMERE
Provider Middle Name:
QUINN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA, SUDPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHACKELFORD
Provider Other First Name:
JULIA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA, SUDPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770353872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12311 32ND AVE NE APT 718
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98125-5770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-403-0615
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4232 198TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-6747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-248-4900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2024

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: 101YA0400X , with the licence number:  CO61490408 , 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)