1780805507 NPI number — TRISTA RAWLINGS LAWRENCE LMP

Table of content: TRISTA RAWLINGS LAWRENCE LMP (NPI 1780805507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780805507 NPI number — TRISTA RAWLINGS LAWRENCE LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
TRISTA
Provider Middle Name:
RAWLINGS
Provider Name Prefix Text:
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:
RAWLINGS
Provider Other First Name:
TRISTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780805507
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:
PO BOX 2647
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAINE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-332-8000
Provider Business Mailing Address Fax Number:
360-371-4085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
477 PEACE PORTAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 5B
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-332-8000
Provider Business Practice Location Address Fax Number:
360-371-4085
Provider Enumeration Date:
05/01/2007

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: 174400000X , with the licence number:  MA00012980 , 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: 140125 . This is a "L&I PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1236RA . This is a "ADDITIONAL RBS PROVIDER N" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1714RA . This is a "RBS PROVIDER NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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