1770655219 NPI number — MRS. ESTHER FERMENICK LMP

Table of content: MRS. ESTHER FERMENICK LMP (NPI 1770655219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770655219 NPI number — MRS. ESTHER FERMENICK LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERMENICK
Provider First Name:
ESTHER
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMP
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:
1770655219
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:
7307 NE 239TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE GROUND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98604-5354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-254-5881
Provider Business Mailing Address Fax Number:
360-254-2763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9805 E MILL PLAIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-5881
Provider Business Practice Location Address Fax Number:
360-254-2763
Provider Enumeration Date:
11/13/2006

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: 225700000X , with the licence number:  MA00018331 , 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: 0205978 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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