1174922199 NPI number — JACOB WESLEY ARMSTRONG ARNP

Table of content: JACOB WESLEY ARMSTRONG ARNP (NPI 1174922199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174922199 NPI number — JACOB WESLEY ARMSTRONG ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMSTRONG
Provider First Name:
JACOB
Provider Middle Name:
WESLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARMSTRONG
Provider Other First Name:
J WESLEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1174922199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 S WELLER ST #266
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-261-5415
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9650 15TH AVE SW
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98106-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-965-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2014

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: 163W00000X , with the licence number:  RN60382287 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP60515710 , 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)