Provider Demographics
NPI:1609630896
Name:KYRYIENKO, ANNA (MA61518117)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KYRYIENKO
Suffix:
Gender:F
Credentials:MA61518117
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11221 PHINNEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8620
Mailing Address - Country:US
Mailing Address - Phone:206-530-0074
Mailing Address - Fax:
Practice Address - Street 1:11221 PHINNEY AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8620
Practice Address - Country:US
Practice Address - Phone:206-530-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61518117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist