1184884892 NPI number — MRS. KRISTINA LAROSE VINCENT LMCHA

Table of content: MRS. KRISTINA LAROSE VINCENT LMCHA (NPI 1184884892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184884892 NPI number — MRS. KRISTINA LAROSE VINCENT LMCHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VINCENT
Provider First Name:
KRISTINA
Provider Middle Name:
LAROSE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMCHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETROSKI
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
LAROSE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CDP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184884892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5455 ALMIRA DR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98311-8330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-415-5807
Provider Business Mailing Address Fax Number:
360-478-0951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5455 ALMIRA DR NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98311-8330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-415-5807
Provider Business Practice Location Address Fax Number:
360-478-0951
Provider Enumeration Date:
06/16/2008

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 , with the licence number:  MC60164768 , 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)





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