1699824292 NPI number — MRS. CHRISTINA KUDABECK L.M.P.

Table of content: MRS. CHRISTINA KUDABECK L.M.P. (NPI 1699824292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699824292 NPI number — MRS. CHRISTINA KUDABECK L.M.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUDABECK
Provider First Name:
CHRISTINA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANTONGIOVANNI
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.P.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699824292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6913 57TH AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98371-4901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-848-6844
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 W STEWART
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98371-5149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-848-6844
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2007

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: 225700000X , with the licence number:  MA00006461 , 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: 36080 . This is a "DEPT OF LABOR &INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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