1316920176 NPI number — MS. SHELLY KURTENBACH RPH

Table of content: MS. SHELLY KURTENBACH RPH (NPI 1316920176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316920176 NPI number — MS. SHELLY KURTENBACH RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURTENBACH
Provider First Name:
SHELLY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1316920176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18800 142ND AVE NE
Provider Second Line Business Mailing Address:
UNIT 4B
Provider Business Mailing Address City Name:
WOODINVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-343-4870
Provider Business Mailing Address Fax Number:
206-343-4884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18800 142ND AVE NE
Provider Second Line Business Practice Location Address:
UNIT 4B
Provider Business Practice Location Address City Name:
WOODINVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-455-2123
Provider Business Practice Location Address Fax Number:
844-965-9828
Provider Enumeration Date:
11/25/2005

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: 183500000X , with the licence number:  P19857 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PH00019857 , 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)