1215958921 NPI number — AMY K MOUAT-HUNTER MD

Table of content: AMY K MOUAT-HUNTER MD (NPI 1215958921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215958921 NPI number — AMY K MOUAT-HUNTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOUAT-HUNTER
Provider First Name:
AMY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOUAT-HUNTER
Provider Other First Name:
AMY
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215958921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2980 SQUALICUM PKWY
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-1880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-647-3377
Provider Business Mailing Address Fax Number:
360-752-3214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2980 SQUALICUM PKWY
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-1880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-647-3377
Provider Business Practice Location Address Fax Number:
360-752-3214
Provider Enumeration Date:
07/21/2006

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: 207L00000X , with the licence number:  MD00045370 , 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: P00300197 . This is a "MEDICARE RR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8435166 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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