Healthcare Provider Details

I. General information

NPI: 1205609013
Provider Name (Legal Business Name): SAMANTHA ALISE KRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 23RD AVE
SEATTLE WA
98122-6025
US

IV. Provider business mailing address

2012 43RD AVE E # 18
SEATTLE WA
98112-2752
US

V. Phone/Fax

Practice location:
  • Phone: 206-252-2277
  • Fax:
Mailing address:
  • Phone: 651-303-9902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN61473300
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: