1821228230 NPI number — MRS. SHAYA ELLEN HONCOOP LMP

Table of content: MRS. SHAYA ELLEN HONCOOP LMP (NPI 1821228230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821228230 NPI number — MRS. SHAYA ELLEN HONCOOP LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HONCOOP
Provider First Name:
SHAYA
Provider Middle Name:
ELLEN
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:
HENDRICKSON
Provider Other First Name:
SHAYA
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821228230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 BICKFORD AVE
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
SNOHOMISH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98290-1769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-319-1123
Provider Business Mailing Address Fax Number:
360-863-2649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 BICKFORD AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
SNOHOMISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98290-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-319-1123
Provider Business Practice Location Address Fax Number:
360-863-2649
Provider Enumeration Date:
07/20/2009

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:  MA60055746 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MA60055746 , 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)





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