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NPI Code Detail

MEDICARE: WHITNEY KRISTINA VAYNTRUB PA-C

MEDICARE: WHITNEY KRISTINA VAYNTRUB PA-C
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
1363A00000XPhysician Assistant61279880WA

General Provider Information

NPI Number : 1639625288
Entity Type Code : Individual
Provider Name (Legal Business Name) : WHITNEY KRISTINA VAYNTRUB PA-C
Provider Business Mailing Address
First Line : 853 WATSON ST N STE 200
Second Line :
City : ENUMCLAW
State : WA
Zip : 98022-3948
Country : US
Telephone Number : 360-367-2970
Fax Number :
Provider Business Practice Location Address
First Line : 853 WATSON ST N STE 200
Second Line :
City : ENUMCLAW
State : WA
Zip : 98022-3948
Country : US
Telephone Number : 360-367-2970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2016
Last Update Date : 12/01/2022

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Directions to “ WHITNEY KRISTINA VAYNTRUB PA-C” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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