Healthcare Provider Details

I. General information

NPI: 1457548471
Provider Name (Legal Business Name): KRISHTA C. ABRUZZINI LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 MAIN ST STE 550D
VANCOUVER WA
98660-2955
US

IV. Provider business mailing address

117 NE 127TH CIR
VANCOUVER WA
98685-3076
US

V. Phone/Fax

Practice location:
  • Phone: 360-910-8065
  • Fax:
Mailing address:
  • Phone: 360-910-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License NumberMA00022103
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: