Healthcare Provider Details

I. General information

NPI: 1770155947
Provider Name (Legal Business Name): KRISTIN KIMBERLY SYLVESTER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 EVERGREEN WAY STE Z154
EVERETT WA
98204-3889
US

IV. Provider business mailing address

211 NOBLE WAY
GRANITE FALLS WA
98252-8703
US

V. Phone/Fax

Practice location:
  • Phone: 425-347-5121
  • Fax:
Mailing address:
  • Phone: 425-231-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP60248092
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: