1598918088 NPI number — HILLARY KRUEGER ADRIAN PAC

Table of content: HILLARY KRUEGER ADRIAN PAC (NPI 1598918088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598918088 NPI number — HILLARY KRUEGER ADRIAN PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADRIAN
Provider First Name:
HILLARY
Provider Middle Name:
KRUEGER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRUEGER
Provider Other First Name:
HILLARY
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598918088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 S KITSAP BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98366-3709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-744-6275
Provider Business Mailing Address Fax Number:
360-744-6270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 S KITSAP BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-744-6275
Provider Business Practice Location Address Fax Number:
360-744-6270
Provider Enumeration Date:
10/28/2008

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: 363AM0700X , with the licence number:  4660 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA60048381 , 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: 549709 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0289408 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2000370 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0302313 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0289416 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0289410 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0289411 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0289414 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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