=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720484231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. CHRISTOPHER JOHN WASHBURN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2014
-----------------------------------------------------
Last Update Date | 11/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6386 CHICO WAY NW
-----------------------------------------------------
City | BREMERTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98312-1154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-509-0319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6386 CHICO WAY NW
-----------------------------------------------------
City | BREMERTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98312-1154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-509-0319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | 709420
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------