Healthcare Provider Details

I. General information

NPI: 1134821192
Provider Name (Legal Business Name): KIRSTEN EVE MOJZISZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE OC.7.830
SEATTLE WA
98105
US

IV. Provider business mailing address

4800 SAND POINT WAY NE OC.7.830
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMDRE.ML.61425305
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: