Healthcare Provider Details

I. General information

NPI: 1598605263
Provider Name (Legal Business Name): CHRISTINE MENDOZA BANTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14915 38TH DR SE UNIT I1113
BOTHELL WA
98012-4223
US

IV. Provider business mailing address

14915 38TH DR SE UNIT I1113
BOTHELL WA
98012-4223
US

V. Phone/Fax

Practice location:
  • Phone: 425-647-3292
  • Fax:
Mailing address:
  • Phone: 425-647-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60440480
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: