1801377825 NPI number — MRS. GURUBANI WHITNEY A VAN BOVEN LMT

Table of content: MRS. GURUBANI WHITNEY A VAN BOVEN LMT (NPI 1801377825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801377825 NPI number — MRS. GURUBANI WHITNEY A VAN BOVEN LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN BOVEN
Provider First Name:
GURUBANI WHITNEY
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KHALSA
Provider Other First Name:
GURUBANI WHITNEY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
WEMT, CPHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801377825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 74
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKPORT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98283-0074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-455-3453
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 E FAIRHAVEN AVE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98233-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-455-3453
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2018

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com