Provider Demographics
NPI:1558693754
Name:BAUDUIN, KRISTINA DAWN (LMP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:DAWN
Last Name:BAUDUIN
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 1:19045 HWY 305
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370
Mailing Address - Country:US
Mailing Address - Phone:360-779-7800
Mailing Address - Fax:360-779-7060
Practice Address - Street 1:19045 HWY 305
Practice Address - Street 2:SUITE 203
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-779-7800
Practice Address - Fax:360-779-7060
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60103812225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist