1932310216 NPI number — ALYCE M. HUNTSINGER FNP, NNP

Table of content: ALYCE M. HUNTSINGER FNP, NNP (NPI 1932310216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932310216 NPI number — ALYCE M. HUNTSINGER FNP, NNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNTSINGER
Provider First Name:
ALYCE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP, NNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUNTSINGER-MICKEL
Provider Other First Name:
ALYCE
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932310216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2480 LIBERTY STREET NE
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-363-8047
Provider Business Mailing Address Fax Number:
503-363-6571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2480 LIBERTY ST NE
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-8380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-363-8047
Provider Business Practice Location Address Fax Number:
503-363-6571
Provider Enumeration Date:
05/25/2007

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: 363LF0000X , with the licence number:  200850051NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LN0000X , with the licence number: 081047091N9 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9644345 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022927 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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