Healthcare Provider Details

I. General information

NPI: 1093810731
Provider Name (Legal Business Name): CAROL JO KALINA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 COLUMBIAN WAY SOUTH (S-111-DERM)
SEATTLE WA
98108-1597
US

IV. Provider business mailing address

PO BOX 1476
MONROE WA
98272-4476
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2305
  • Fax: 206-764-2689
Mailing address:
  • Phone: 206-764-2305
  • Fax: 206-764-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number83922
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: