Provider Demographics
NPI:1376543918
Name:SOLTYSIAK, KRYSTYNA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KRYSTYNA
Middle Name:
Last Name:SOLTYSIAK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21108 NE 42ND ST
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6014
Mailing Address - Country:US
Mailing Address - Phone:425-818-0152
Mailing Address - Fax:
Practice Address - Street 1:200 ANDOVER PARK E STE 3
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2938
Practice Address - Country:US
Practice Address - Phone:206-588-1722
Practice Address - Fax:206-242-2275
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006791363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8867351OtherMEDICARE PTAN