Provider Demographics
NPI:1770025827
Name:PARDO, KRISTYN (RN BSN)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:PARDO
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:TROUT LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98650-0385
Mailing Address - Country:US
Mailing Address - Phone:503-453-6511
Mailing Address - Fax:
Practice Address - Street 1:501 NE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-1826
Practice Address - Country:US
Practice Address - Phone:509-493-6207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60411572163W00000X
OR201390165RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse