1770627952 NPI number — MRS. PRISCILLA ANNE COYNER MPT PCS

Table of content: MRS. PRISCILLA ANNE COYNER MPT PCS (NPI 1770627952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770627952 NPI number — MRS. PRISCILLA ANNE COYNER MPT PCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COYNER
Provider First Name:
PRISCILLA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT PCS
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:
1770627952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14917 256TH AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISSAQUAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98027-8333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-392-7989
Provider Business Mailing Address Fax Number:
425-391-2554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 NW JUNIPER ST
Provider Second Line Business Practice Location Address:
SUITE104
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-392-7989
Provider Business Practice Location Address Fax Number:
425-391-2554
Provider Enumeration Date:
02/19/2007

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:  PT00002750 , 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: CO2118 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7038037 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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