Provider Demographics
NPI:1508269176
Name:FRENCH, KRISTAN NICOLE (LMP)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:NICOLE
Last Name:FRENCH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 EAGLEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:PORT LUDLOW
Mailing Address - State:WA
Mailing Address - Zip Code:98365-9283
Mailing Address - Country:US
Mailing Address - Phone:360-301-1101
Mailing Address - Fax:
Practice Address - Street 1:11430 51ST AVE NW
Practice Address - Street 2:SUITE 101 A
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-7897
Practice Address - Country:US
Practice Address - Phone:253-857-6500
Practice Address - Fax:253-857-2225
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60503671225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist