Provider Demographics
NPI:1639625288
Name:VAYNTRUB, WHITNEY KRISTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:KRISTINA
Last Name:VAYNTRUB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 WATSON ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3948
Mailing Address - Country:US
Mailing Address - Phone:360-367-2970
Mailing Address - Fax:
Practice Address - Street 1:853 WATSON ST N STE 200
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3948
Practice Address - Country:US
Practice Address - Phone:360-367-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61279880363A00000X
RIPA01032363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant