1689889099 NPI number — KIRSTEN F NYGAARD PA-C

Table of content: KIRSTEN F NYGAARD PA-C (NPI 1689889099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689889099 NPI number — KIRSTEN F NYGAARD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NYGAARD
Provider First Name:
KIRSTEN
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1689889099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 16TH AVE E
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:
98112-5211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-326-3000
Provider Business Mailing Address Fax Number:
206-326-2785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 BROADWAY
Provider Second Line Business Practice Location Address:
STE 340
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-5229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-215-2520
Provider Business Practice Location Address Fax Number:
206-386-3180
Provider Enumeration Date:
05/11/2007

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: 363A00000X , with the licence number:  PA1005127 , 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: 0299724 . This is a "LABOR AND INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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