1215023619 NPI number — MRS. KRISTINE ELIZABETH GOEDHARD CTRS

Table of content: MRS. KRISTINE ELIZABETH GOEDHARD CTRS (NPI 1215023619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215023619 NPI number — MRS. KRISTINE ELIZABETH GOEDHARD CTRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOEDHARD
Provider First Name:
KRISTINE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CTRS
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:
1215023619
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:
15927 SE 179TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-793-0573
Provider Business Mailing Address Fax Number:
206-764-2263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VA PUGET SOUND HEALTH CARE SYSTEM
Provider Second Line Business Practice Location Address:
1660 S. COLUMBIAN WAY (S-117-RCS)
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-277-6683
Provider Business Practice Location Address Fax Number:
206-764-2263
Provider Enumeration Date:
10/04/2006

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: 225800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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