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NPI Code Detail

MEDICARE: KRISTIN LATOUSEK CCP.

MEDICARE:   KRISTIN  LATOUSEK  CCP.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractorWA

General Provider Information

NPI Number : 1063637098
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN LATOUSEK CCP.
Provider Business Mailing Address
First Line : 526 1ST AVE S APT 511
Second Line :
City : SEATTLE
State : WA
Zip : 98104-2863
Country : US
Telephone Number : 206-382-8380
Fax Number :
Provider Business Practice Location Address
First Line : 526 1ST AVE S APT 511
Second Line :
City : SEATTLE
State : WA
Zip : 98104-2863
Country : US
Telephone Number : 206-382-8380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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Directions to “ KRISTIN LATOUSEK CCP.” Practice Location

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