MEDICARE: MS. KRISTINE ATWOOD AVERY RN, BSN, LCCE, FACCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator	RN 00158069	WA

General Provider Information

NPI Number	:	1194056408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINE ATWOOD AVERY RN, BSN, LCCE, FACCE

Provider Business Mailing Address
First Line	:	4502 SORREL AVE NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-4027
Country	:	US
Telephone Number	:	206-245-6997
Fax Number	:	206-780-0501

Provider Business Practice Location Address
First Line	:	4502 SORREL AVE NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-4027
Country	:	US
Telephone Number	:	206-245-6997
Fax Number	:	206-780-0501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	01/26/2010

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