1639352560 NPI number — DR. KRISTI A LINSENMAYER DDS MPH MSD

Table of content: DR. KRISTI A LINSENMAYER DDS MPH MSD (NPI 1639352560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639352560 NPI number — DR. KRISTI A LINSENMAYER DDS MPH MSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINSENMAYER
Provider First Name:
KRISTI
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS MPH MSD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINSENMAYER
Provider Other First Name:
KRISTI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS MPH MSD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639352560
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:
PO BOX 3364
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98114-3364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-324-9360
Provider Business Mailing Address Fax Number:
206-324-8910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 12TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-324-9360
Provider Business Practice Location Address Fax Number:
206-324-8910
Provider Enumeration Date:
12/13/2007

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: 122300000X , with the licence number:  DE00007075 , 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: DE00007075 . This is a "LICENSE NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5017983 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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