Provider Demographics
NPI:1033388988
Name:RUBIS, KRISTEN R (LMP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:R
Last Name:RUBIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CLARK PL SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4062
Mailing Address - Country:US
Mailing Address - Phone:360-534-4716
Mailing Address - Fax:
Practice Address - Street 1:205 CLARK PL SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4062
Practice Address - Country:US
Practice Address - Phone:360-534-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist