Healthcare Provider Details

I. General information

NPI: 1316650682
Provider Name (Legal Business Name): CHRISTINE THERESE BRONIAK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 3RD ST SE STE 240
PUYALLUP WA
98372-3771
US

IV. Provider business mailing address

7508 120TH ST E APT A
PUYALLUP WA
98373-4808
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-1420
  • Fax:
Mailing address:
  • Phone: 503-991-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOL70011268
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: