1912109729 NPI number — ANNE MARJORIE ERICKSON-HARE OTA

Table of content: ANNE MARJORIE ERICKSON-HARE OTA (NPI 1912109729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912109729 NPI number — ANNE MARJORIE ERICKSON-HARE OTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERICKSON-HARE
Provider First Name:
ANNE
Provider Middle Name:
MARJORIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTA
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:
1912109729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2256 WOODBINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANGLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98260-8222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-321-2548
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 NE 3RD ST
Provider Second Line Business Practice Location Address:
CAREAGE OF WHIDBEY
Provider Business Practice Location Address City Name:
COUPEVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98239-3427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-678-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2007

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: 314000000X , with the licence number:  OC00000930 , 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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