Provider Demographics
NPI:1790466738
Name:HENRIQUEZ, KIMBERLY DAJANNA
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAJANNA
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10018 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7406
Mailing Address - Country:US
Mailing Address - Phone:410-564-6953
Mailing Address - Fax:
Practice Address - Street 1:1410 NE CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0003
Practice Address - Country:US
Practice Address - Phone:206-543-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61050114163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse