Provider Demographics
NPI:1114545258
Name:VISSER, KRISTI LYNN
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:VISSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WOBURN ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-3865
Mailing Address - Country:US
Mailing Address - Phone:360-715-5321
Mailing Address - Fax:360-715-5338
Practice Address - Street 1:2900 WOBURN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3865
Practice Address - Country:US
Practice Address - Phone:360-715-5321
Practice Address - Fax:360-715-5338
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00043466183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician