1376543918 NPI number — MS. KRYSTYNA SOLTYSIAK ARNP

Table of content: MS. KRYSTYNA SOLTYSIAK ARNP (NPI 1376543918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376543918 NPI number — MS. KRYSTYNA SOLTYSIAK ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLTYSIAK
Provider First Name:
KRYSTYNA
Provider Middle Name:
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:
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:
1376543918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21108 NE 42ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAMMAMISH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98074-6014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-818-0152
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ANDOVER PARK E STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUKWILA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98188-2938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-588-1722
Provider Business Practice Location Address Fax Number:
206-242-2275
Provider Enumeration Date:
07/26/2005

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: 363LA2200X , with the licence number:  AP30006791 , 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: G8867351 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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