Provider Demographics
NPI:1497530604
Name:BLUNT, KRISTINA DIANE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:DIANE
Last Name:BLUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19619 SE 264TH CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5034
Mailing Address - Country:US
Mailing Address - Phone:253-880-5563
Mailing Address - Fax:
Practice Address - Street 1:1410 NE CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0003
Practice Address - Country:US
Practice Address - Phone:206-543-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program