Provider Demographics
NPI:1548793268
Name:KITUR, CAROLYNE
Entity Type:Individual
Prefix:
First Name:CAROLYNE
Middle Name:
Last Name:KITUR
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 1:606 OAKESDALE AVE SW
Mailing Address - Street 2:STE C200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5227
Mailing Address - Country:US
Mailing Address - Phone:866-259-1629
Mailing Address - Fax:
Practice Address - Street 1:606 OAKESDALE AVE SW
Practice Address - Street 2:STE C200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5227
Practice Address - Country:US
Practice Address - Phone:866-259-1629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60740607363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology