1992248769 NPI number — MS. ROCHELLE ANIK MANWARING

Table of content: MS. ROCHELLE ANIK MANWARING (NPI 1992248769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992248769 NPI number — MS. ROCHELLE ANIK MANWARING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANWARING
Provider First Name:
ROCHELLE
Provider Middle Name:
ANIK
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANWARING
Provider Other First Name:
SHELLEY
Provider Other Middle Name:
ANIK
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1992248769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97071-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-983-5260
Provider Business Mailing Address Fax Number:
971-983-5326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 BENNETT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97504-6715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-779-5228
Provider Business Practice Location Address Fax Number:
541-772-1533
Provider Enumeration Date:
11/29/2016

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: 1041C0700X , with the licence number:  L6591 , 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)

  • Identifier: L6591 . This is a "OREGON STATE BOARD OF LICENSED SOCIAL WORKERS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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