Healthcare Provider Details

I. General information

NPI: 1114959400
Provider Name (Legal Business Name): WENDY R KUDRITZKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 TALLMAN AVE NW
SEATTLE WA
98107-3932
US

IV. Provider business mailing address

3419 NW 65TH ST
SEATTLE WA
98117-6018
US

V. Phone/Fax

Practice location:
  • Phone: 603-490-4206
  • Fax:
Mailing address:
  • Phone: 603-490-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60183108
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: