Provider Demographics
NPI:1063830586
Name:EASTSIDE WOMEN'S HEALTH & LACTATION, PLLC
Entity Type:Organization
Organization Name:EASTSIDE WOMEN'S HEALTH & LACTATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, ARNP
Authorized Official - Phone:425-814-2045
Mailing Address - Street 1:13128 TOTEM LAKE BLVD NE
Mailing Address - Street 2:SUITE104
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2953
Mailing Address - Country:US
Mailing Address - Phone:425-814-2045
Mailing Address - Fax:425-814-2783
Practice Address - Street 1:13128 TOTEM LAKE BLVD NE
Practice Address - Street 2:SUITE104
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2953
Practice Address - Country:US
Practice Address - Phone:425-814-2045
Practice Address - Fax:425-814-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABUS19862261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility