Provider Demographics
NPI:1164571873
Name:STAPLETON, KRISTINE K (LMP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:K
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4569 LYNWOOD CENTER RD NE STE 12
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE IS
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2242
Mailing Address - Country:US
Mailing Address - Phone:206-780-9121
Mailing Address - Fax:206-780-8899
Practice Address - Street 1:4569 LYNWOOD CENTER RD NE STE 12
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE IS
Practice Address - State:WA
Practice Address - Zip Code:98110-2242
Practice Address - Country:US
Practice Address - Phone:206-780-9121
Practice Address - Fax:206-780-8899
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006376171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor