Provider Demographics
NPI:1407852742
Name:KREITER, LAURIE L (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:L
Last Name:KREITER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:M4-PFS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:206-341-0274
Practice Address - Street 1:19116 33RD AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4706
Practice Address - Country:US
Practice Address - Phone:425-712-7900
Practice Address - Fax:425-712-7905
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA080181371OtherRAILROAD MEDICARE
WA8297731Medicaid
G44955Medicare UPIN