Provider Demographics
NPI:1093126567
Name:KIRSCHNER, GARY DALE (NA-R, NA-C, RT)
Entity Type:Individual
Prefix:MRS
First Name:GARY
Middle Name:DALE
Last Name:KIRSCHNER
Suffix:
Gender:F
Credentials:NA-R, NA-C, RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24230 85TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-9525
Mailing Address - Country:US
Mailing Address - Phone:206-618-1803
Mailing Address - Fax:
Practice Address - Street 1:24230 85TH AVE SE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9525
Practice Address - Country:US
Practice Address - Phone:206-618-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAXT60472548247100000X
WANC603264253747A0650X
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider