1952733065 NPI number — MISS DEBORAH NOELLE KALINOSKI RDH

Table of content: MISS DEBORAH NOELLE KALINOSKI RDH (NPI 1952733065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952733065 NPI number — MISS DEBORAH NOELLE KALINOSKI RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALINOSKI
Provider First Name:
DEBORAH
Provider Middle Name:
NOELLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RDH
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:
1952733065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12325 SW HORIZON BLVD STE 229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97007-9475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-205-5822
Provider Business Mailing Address Fax Number:
503-590-0300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12325 SW HORIZON BLVD STE 229
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97007-9475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-205-5822
Provider Business Practice Location Address Fax Number:
503-590-0300
Provider Enumeration Date:
07/31/2013

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: 124Q00000X , with the licence number:  H6130 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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