Healthcare Provider Details

I. General information

NPI: 1568409019
Provider Name (Legal Business Name): KRISTINA K BAUER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104
US

IV. Provider business mailing address

PO BOX 31001-1518
PASADENA CA
91110-1518
US

V. Phone/Fax

Practice location:
  • Phone: 206-731-3241
  • Fax:
Mailing address:
  • Phone: 844-364-2778
  • Fax: 253-428-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30006005
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP300065005
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: