1285609255 NPI number — DR. KRISTIINA K HUCKABAY AUD

Table of content: DR. KRISTIINA K HUCKABAY AUD (NPI 1285609255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285609255 NPI number — DR. KRISTIINA K HUCKABAY AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUCKABAY
Provider First Name:
KRISTIINA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
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:
1285609255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98122-5395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-215-1770
Provider Business Mailing Address Fax Number:
206-215-1771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-5395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-215-1770
Provider Business Practice Location Address Fax Number:
206-215-1771
Provider Enumeration Date:
02/22/2006

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: 231H00000X , with the licence number:  LD00002271 , 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: KO4477 . This is a "INDIVIDUAL BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0039572 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8338931 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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