1801016159 NPI number — VIRGINIA LYNN CHARD LMP

Table of content: VIRGINIA LYNN CHARD LMP (NPI 1801016159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801016159 NPI number — VIRGINIA LYNN CHARD LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARD
Provider First Name:
VIRGINIA
Provider Middle Name:
LYNN
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:
BARNHILL
Provider Other First Name:
VIRGINIA
Provider Other Middle Name:
LYNN
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:
1801016159
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:
8202 SR 104
Provider Second Line Business Mailing Address:
SUITE 102 #37
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-271-7966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8202 SR 104
Provider Second Line Business Practice Location Address:
SUITE 102 #37
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-271-7966
Provider Business Practice Location Address Fax Number:
360-876-6083
Provider Enumeration Date:
04/27/2007

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: 225700000X , with the licence number:  MA00016525 , 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: MA00016525 . This is a "STATE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: BL01447 . This is a "POULSBO BUSINESS LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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