MEDICARE: PRIMARY CARE SEQUIM PLLC

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	363LF0000X	Family Nurse Practitioner	AP30005000	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1780625400	OTHER	WA	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1558374884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE SEQUIM PLLC

Provider Business Mailing Address
First Line	:	520 N 5TH AVE
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-3079
Country	:	US
Telephone Number	:	360-582-1200
Fax Number	:	360-582-1230

Provider Business Practice Location Address
First Line	:	520 N 5TH AVE
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-3079
Country	:	US
Telephone Number	:	360-582-1200
Fax Number	:	360-582-1230

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. BRIDGETT BELL KRAFT
Credential	:	MS, ARNP
Telephone Number	:	360-582-1200

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	12/06/2007

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