1922246883 NPI number — MRS. PATRICIA LOUISE ODIORNE RD, CDE

Table of content: MRS. PATRICIA LOUISE ODIORNE RD, CDE (NPI 1922246883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922246883 NPI number — MRS. PATRICIA LOUISE ODIORNE RD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ODIORNE
Provider First Name:
PATRICIA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CDE
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:
1922246883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 HOWANUT
Provider Second Line Business Mailing Address:
P.O. BOX 570
Provider Business Mailing Address City Name:
OAKVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-709-1884
Provider Business Mailing Address Fax Number:
360-858-7300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 NIEDERMAN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-709-1884
Provider Business Practice Location Address Fax Number:
360-858-7300
Provider Enumeration Date:
01/30/2009

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: 133V00000X , with the licence number:  R334668 , 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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