1861510695 NPI number — MRS. HEATHER MARIDAWN GILMAN LMP

Table of content: MRS. HEATHER MARIDAWN GILMAN LMP (NPI 1861510695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861510695 NPI number — MRS. HEATHER MARIDAWN GILMAN LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILMAN
Provider First Name:
HEATHER
Provider Middle Name:
MARIDAWN
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:
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:
1861510695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2214 113TH DR SE UNIT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE STEVENS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98258-5122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-249-6766
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 95TH DR NE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE STEVENS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98258-7976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-334-9137
Provider Business Practice Location Address Fax Number:
425-377-9487
Provider Enumeration Date:
03/27/2007

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:  MA00021150 , 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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