Healthcare Provider Details

I. General information

NPI: 1952864522
Provider Name (Legal Business Name): KIANA ECCLESTONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23960 35TH PL S
KENT WA
98032-3784
US

IV. Provider business mailing address

3700 SOUTHCENTER BLVD APT 127
TUKWILA WA
98188-2254
US

V. Phone/Fax

Practice location:
  • Phone: 206-824-6207
  • Fax: 206-824-2629
Mailing address:
  • Phone: 360-540-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: