Healthcare Provider Details

I. General information

NPI: 1093021925
Provider Name (Legal Business Name): CHRISANNE KUCZMARSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N BROADWAY
EVERETT WA
98201-1409
US

IV. Provider business mailing address

930 N BROADWAY
EVERETT WA
98201-1409
US

V. Phone/Fax

Practice location:
  • Phone: 425-595-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number281861
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61351968
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ7728
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: