Provider Demographics
NPI:1043324130
Name:NYTE, CHRISTOPHER PHILIP
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PHILIP
Last Name:NYTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27539 MAPLE VALLEY BLACK DIAMOND RD SE
Mailing Address - Street 2:SUITED101
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5155
Mailing Address - Country:US
Mailing Address - Phone:425-413-6517
Mailing Address - Fax:425-413-0218
Practice Address - Street 1:27539 MAPLE VALLEY BLACK DIAMOND RD SE
Practice Address - Street 2:SUITE D101
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5155
Practice Address - Country:US
Practice Address - Phone:425-413-6517
Practice Address - Fax:425-413-0218
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001936207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG65585Medicare UPIN