1487354551 NPI number — EMERALD KAITRYN MS, GC

Table of content: EMERALD KAITRYN MS, GC (NPI 1487354551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487354551 NPI number — EMERALD KAITRYN MS, GC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAITRYN
Provider First Name:
EMERALD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, GC
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:
1487354551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DIVISION OF MEDICAL GENETICS, BOX 357720
Provider Second Line Business Mailing Address:
HEALTH SCIENCES BUILDING 1705 NE PACIFIC ST, RM K236F
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-543-4184
Provider Business Mailing Address Fax Number:
206-543-8820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DIVISION OF MEDICAL GENETICS, BOX
Provider Second Line Business Practice Location Address:
HEALTH SCIENCES BUILDING 1705 NE PACIFIC ST, RM K236F
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-4184
Provider Business Practice Location Address Fax Number:
206-543-8820
Provider Enumeration Date:
03/07/2023

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GCPL.GP.61414286 . This is a "WASHINGTON DEPARTMENT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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