1821397811 NPI number — ASHLEY MARIE-LOUISE FOGWELL ASHLEY FOGWELL

Table of content: ASHLEY MARIE-LOUISE FOGWELL ASHLEY FOGWELL (NPI 1821397811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821397811 NPI number — ASHLEY MARIE-LOUISE FOGWELL ASHLEY FOGWELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOGWELL
Provider First Name:
ASHLEY
Provider Middle Name:
MARIE-LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ASHLEY FOGWELL
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:
1821397811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5680 S 152ND ST
Provider Second Line Business Mailing Address:
APT 10
Provider Business Mailing Address City Name:
TUKWILA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98188-2481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-422-6419
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4122 FACTORIA BLVD SE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98006-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-590-9619
Provider Business Practice Location Address Fax Number:
425-590-9641
Provider Enumeration Date:
03/16/2011

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:  MA60210193 , 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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