Provider Demographics
NPI:1073852315
Name:DANFORTH, KRISTY ANN (RN)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:ANN
Last Name:DANFORTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 OTIS BEACH ST NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-9539
Mailing Address - Country:US
Mailing Address - Phone:206-890-4910
Mailing Address - Fax:888-381-2007
Practice Address - Street 1:9128 OTIS BEACH ST NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-9539
Practice Address - Country:US
Practice Address - Phone:206-890-4910
Practice Address - Fax:888-381-2007
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00088775163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse