Provider Demographics
NPI:1477845089
Name:GOWIN, KRISSTINA LORRAINE (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISSTINA
Middle Name:LORRAINE
Last Name:GOWIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 PACIFIC HWY E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-1148
Mailing Address - Country:US
Mailing Address - Phone:253-382-6300
Mailing Address - Fax:
Practice Address - Street 1:3700 PACIFIC HWY E
Practice Address - Street 2:SUITE 100
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-1148
Practice Address - Country:US
Practice Address - Phone:253-382-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11576207R00000X
AZ5853207RH0003X
AZAZ005853207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ716662Medicaid
AZP01176255OtherRR MEDICARE
AZZ154908Medicare PIN