Healthcare Provider Details

I. General information

NPI: 1811613623
Provider Name (Legal Business Name): JATINDER KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SW 148TH ST
BURIEN WA
98166-1924
US

IV. Provider business mailing address

110 SW 148TH ST
BURIEN WA
98166-1924
US

V. Phone/Fax

Practice location:
  • Phone: 206-835-0166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60644925
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: