Provider Demographics
NPI:1659831386
Name:DAVENPORT-WELTER, CHRISTINE EILEEN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:EILEEN
Last Name:DAVENPORT-WELTER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:EILEEN
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:253-681-6626
Mailing Address - Fax:
Practice Address - Street 1:17707 W MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1967
Practice Address - Country:US
Practice Address - Phone:360-282-7885
Practice Address - Fax:360-512-2026
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60956784207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2134058Medicaid