1992248769 NPI number — MS. ROCHELLE ANIK MANWARING

Table of Contents

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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