Provider Demographics
NPI:1780019976
Name:HART, KRISTEN REMICK (LMP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:REMICK
Last Name:HART
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 1:555 108TH AVE NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5578
Mailing Address - Country:US
Mailing Address - Phone:425-452-9280
Mailing Address - Fax:
Practice Address - Street 1:555 108TH AVE NE
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5578
Practice Address - Country:US
Practice Address - Phone:425-452-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60310067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist