1831625490 NPI number — MRS. MICAH LAURAINE INGALLS B.S.

Table of content: MRS. MICAH LAURAINE INGALLS B.S. (NPI 1831625490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831625490 NPI number — MRS. MICAH LAURAINE INGALLS B.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INGALLS
Provider First Name:
MICAH
Provider Middle Name:
LAURAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
B.S.
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:
1831625490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8928 NE COUCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97220-5945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-276-9639
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8815 S TACOMA WAY
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-4587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-682-0320
Provider Business Practice Location Address Fax Number:
253-582-2901
Provider Enumeration Date:
05/02/2017

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: 103K00000X ; 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