MEDICARE: KIRSTEN BEHRENS RN, BSN, PHN

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
1	163WP0200X	Pediatric Registered Nurse	RN60488463	WA

General Provider Information

NPI Number	:	1972905610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN BEHRENS RN, BSN, PHN

Provider Business Mailing Address
First Line	:	215 166TH ST S
Second Line	:
City	:	SPANAWAY
State	:	WA
Zip	:	98387-8624
Country	:	US
Telephone Number	:	253-298-4661
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 166TH ST S
Second Line	:
City	:	SPANAWAY
State	:	WA
Zip	:	98387-8624
Country	:	US
Telephone Number	:	253-298-4661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	03/11/2021

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