Provider Demographics
NPI:1346447653
Name:ADVANCED FAMILY WELLNESS PS
Entity Type:Organization
Organization Name:ADVANCED FAMILY WELLNESS PS
Other - Org Name:ADVANCED FAMILY WELLNESS INC PS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:IRENE KREINBRINK
Authorized Official - Last Name:KATHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:369-570-8010
Mailing Address - Street 1:1115 WEST BAY DR NW SUITE 202
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502
Mailing Address - Country:US
Mailing Address - Phone:360-570-8010
Mailing Address - Fax:360-570-8009
Practice Address - Street 1:1115 WEST BAY DR NW SUITE 202
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-570-8010
Practice Address - Fax:360-570-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty