1821104225 NPI number — MRS. KIMBERLY BLAKE SATENBERG

Table of content: MRS. KIMBERLY BLAKE SATENBERG (NPI 1821104225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821104225 NPI number — MRS. KIMBERLY BLAKE SATENBERG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SATENBERG
Provider First Name:
KIMBERLY
Provider Middle Name:
BLAKE
Provider Name Prefix Text:
MRS.
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:
BLAKE
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1821104225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1747 268TH PL SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAMMAMISH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-557-0360
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 3RD AVE NE
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-853-6529
Provider Business Practice Location Address Fax Number:
425-557-0360
Provider Enumeration Date:
08/21/2006

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: 103TC0700X , with the licence number:  PY2588 , 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)