1992235964 NPI number — DR. ELIZABETH EILEEN HUBERT PHD

Table of content: DR. ELIZABETH EILEEN HUBERT PHD (NPI 1992235964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992235964 NPI number — DR. ELIZABETH EILEEN HUBERT PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBERT
Provider First Name:
ELIZABETH
Provider Middle Name:
EILEEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1992235964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
955 POWELL AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-2908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4424 S 188TH ST BLDG 900
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATAC
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98188-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-277-7210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2017

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: 103T00000X , with the licence number:  PY60939336 , 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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