MEDICARE: MS. KASSANDRA LINN WHITE RN

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	163W00000X	Registered Nurse	RN00169392	WA

General Provider Information

NPI Number	:	1932443249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KASSANDRA LINN WHITE RN

Provider Business Mailing Address
First Line	:	1819 N 135TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-7709
Country	:	US
Telephone Number	:	206-252-3887
Fax Number	:

Provider Business Practice Location Address
First Line	:	1819 N 135TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-7709
Country	:	US
Telephone Number	:	206-252-3887
Fax Number	:

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

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	11/27/2012

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