1942875950 NPI number — ASHLYNN KAYE WIGEN SKILLS BULDERS

Table of content: ASHLYNN KAYE WIGEN SKILLS BULDERS (NPI 1942875950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942875950 NPI number — ASHLYNN KAYE WIGEN SKILLS BULDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIGEN
Provider First Name:
ASHLYNN
Provider Middle Name:
KAYE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SKILLS BULDERS
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:
1942875950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1387
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAYDEN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83835-1387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-415-0299
Provider Business Mailing Address Fax Number:
208-625-0299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6795 N MINERAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83815-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-769-4222
Provider Business Practice Location Address Fax Number:
844-803-7399
Provider Enumeration Date:
05/21/2021

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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