1902005549 NPI number — JENNY RORABACK-CARSON MD

Table of content: JENNY RORABACK-CARSON MD (NPI 1902005549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902005549 NPI number — JENNY RORABACK-CARSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RORABACK-CARSON
Provider First Name:
JENNY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1902005549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 359753
Provider Second Line Business Mailing Address:
325 9TH AVE
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
206-744-3270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HARBORVIEW SENIOR CARE CLINIC (3WC)
Provider Second Line Business Practice Location Address:
325 9TH AVE
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-744-5415
Provider Business Practice Location Address Fax Number:
206-744-3270
Provider Enumeration Date:
07/13/2007

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: 207R00000X , with the licence number:  MD60100998 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: MD60100998 , 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)

  • Identifier: MD60100998 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1902005549 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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