Healthcare Provider Details

I. General information

NPI: 1376543918
Provider Name (Legal Business Name): KRYSTYNA SOLTYSIAK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ANDOVER PARK E STE 3
TUKWILA WA
98188-2938
US

IV. Provider business mailing address

21108 NE 42ND ST
SAMMAMISH WA
98074-6014
US

V. Phone/Fax

Practice location:
  • Phone: 206-588-1722
  • Fax: 206-242-2275
Mailing address:
  • Phone: 425-818-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30006791
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: