Healthcare Provider Details

I. General information

NPI: 1962853127
Provider Name (Legal Business Name): KIRSTEN ROBERTSON BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

IV. Provider business mailing address

214 SUMMIT AVE E APT 408
SEATTLE WA
98102-5654
US

V. Phone/Fax

Practice location:
  • Phone: 206-322-7676
  • Fax:
Mailing address:
  • Phone: 615-424-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: