Healthcare Provider Details

I. General information

NPI: 1548503261
Provider Name (Legal Business Name): KAITLYN WALD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN ABIGAIL WURZ

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728-134TH STREET SW SEATTLE REPRODUCTIVE MEDICINE SUITE 207
EVERETT WA
98204
US

IV. Provider business mailing address

728-134TH STREET SW SEATTLE REPRODUCTIVE MEDICINE SUITE 207
EVERETT WA
98204
US

V. Phone/Fax

Practice location:
  • Phone: 206-301-5000
  • Fax:
Mailing address:
  • Phone: 206-301-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD61072741
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: