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General NPI Number Information
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NPI Number | 1801368139
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Entity Type | Individual
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Provider Name | KAELIN VINCE CRUZ ARNP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 118 7TH AVE SW
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City | PUYALLUP
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State | WA
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Zip | 98371-6803
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Country | US
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Telephone | 253-250-3888
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Fax |
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Provider Business Mailing Address
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Address Line | 34701 6TH AVE SW
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City | FEDERAL WAY
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State | WA
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Zip | 98023-8447
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Country | US
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Telephone | 253-880-6261
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61085950
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License Number State | WA
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