1902847296 NPI number — STEPHEN LAWRENCE BOULANGER RPH.

Table of content: STEPHEN LAWRENCE BOULANGER RPH. (NPI 1902847296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902847296 NPI number — STEPHEN LAWRENCE BOULANGER RPH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOULANGER
Provider First Name:
STEPHEN
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOULANGER
Provider Other First Name:
STEVE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1902847296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20232 21ST AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHORELINE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98177-2314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22316 70TH AVE W STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-2184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-673-5200
Provider Business Practice Location Address Fax Number:
425-673-5230
Provider Enumeration Date:
06/09/2006

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: 183500000X , with the licence number:  PH00013587 , 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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