1831536184 NPI number — JENNIFER D AMBRIZ MASTER ED

Table of content: JENNIFER D AMBRIZ MASTER ED (NPI 1831536184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831536184 NPI number — JENNIFER D AMBRIZ MASTER ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMBRIZ
Provider First Name:
JENNIFER
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASTER ED
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:
1831536184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99403-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-758-3341
Provider Business Mailing Address Fax Number:
509-769-6057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99403-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-758-3341
Provider Business Practice Location Address Fax Number:
509-769-6057
Provider Enumeration Date:
05/28/2013

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000001 . This is a "WA STATE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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