Provider Demographics
NPI:1518231620
Name:WARMINGTON, KALI BLOSSOM (LMP)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:BLOSSOM
Last Name:WARMINGTON
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 1:14391 N CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-8543
Mailing Address - Country:US
Mailing Address - Phone:208-691-7491
Mailing Address - Fax:
Practice Address - Street 1:605 N SHETLAND CT
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5447
Practice Address - Country:US
Practice Address - Phone:208-457-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00017635172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker