1366131104 NPI number — MS. KRYSTAL MERCEDES ORTH SUND ARNP

Table of content: MS. KRYSTAL MERCEDES ORTH SUND ARNP (NPI 1366131104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366131104 NPI number — MS. KRYSTAL MERCEDES ORTH SUND ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTH SUND
Provider First Name:
KRYSTAL
Provider Middle Name:
MERCEDES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORTH
Provider Other First Name:
KRYSTAL
Provider Other Middle Name:
MERCEDES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366131104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22000 MARINE VIEW DR S STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98198-6233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-592-5960
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22000 MARINE VIEW DR S STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98198-6233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-592-5960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2023

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: 207Q00000X , with the licence number:  AP61578644 , 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)





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