Healthcare Provider Details

I. General information

NPI: 1699425504
Provider Name (Legal Business Name): KENDRA MANZONI MARTINEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA MANZONI CROWE RN

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 NW MYHRE RD STE 1220
SILVERDALE WA
98383-8676
US

IV. Provider business mailing address

17408 HALLMAN RD NW
POULSBO WA
98370-8264
US

V. Phone/Fax

Practice location:
  • Phone: 360-698-4500
  • Fax: 360-698-6960
Mailing address:
  • Phone: 253-820-0271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61436670
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61436670
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: