Healthcare Provider Details

I. General information

NPI: 1548838691
Provider Name (Legal Business Name): LUKAS DANIEL KRUIDENIER MS, GC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

2201 4TH AVE APT 219
SEATTLE WA
98121-2051
US

V. Phone/Fax

Practice location:
  • Phone: 970-590-7119
  • Fax: 206-987-2495
Mailing address:
  • Phone: 970-590-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: