Provider Demographics
NPI:1215568357
Name:SEIDERS-WERNER, KRISTI A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:A
Last Name:SEIDERS-WERNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 MARVIN RD NE STE C-448
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3878
Mailing Address - Country:US
Mailing Address - Phone:360-731-0342
Mailing Address - Fax:
Practice Address - Street 1:14814 93RD BLVD NE APT I208
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-4541
Practice Address - Country:US
Practice Address - Phone:360-731-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61026558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily