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General NPI Number Information
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NPI Number | 1003299769
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Entity Type | Individual
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Provider Name | CHASTITY KRIBBLE
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Gender | Female
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 22002 64TH AVE W SUITE M11A
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City | MLT
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State | WA
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Zip | 98043
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Country | US
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Telephone | 206-818-0028
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Fax | 425-984-0112
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Provider Business Mailing Address
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Address Line | 18705 126TH AVE NE APT 2721
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City | BOTHELL
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State | WA
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Zip | 98011-9349
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA60443424
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License Number State | WA
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