Provider Demographics
NPI:1508883323
Name:KILDOW, GERALDINE A (ARNP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:A
Last Name:KILDOW
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 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:3500 ORCHARD PL
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1749
Practice Address - Country:US
Practice Address - Phone:360-671-3900
Practice Address - Fax:360-647-0882
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3244KIOtherREGENCE BLUESHIELD
WA0500013379OtherRAILROAD MEDICARE
WA8932019OtherL & I (CRIME VICTIM)
WA0070741OtherL & I (REGULAR)
WA423898034OtherGROUP HEALTH COOPERATIVE
WA8553208Medicaid
WA8553208Medicaid
WA0070741OtherL & I (REGULAR)