Provider Demographics
NPI:1922071802
Name:BRECHT, KRISTINE SUSANNE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:SUSANNE
Last Name:BRECHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12843 SHORECREST DR SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3006
Mailing Address - Country:US
Mailing Address - Phone:774-239-1396
Mailing Address - Fax:
Practice Address - Street 1:14212 AMBAUM BLVD SW
Practice Address - Street 2:SUITE 304
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1449
Practice Address - Country:US
Practice Address - Phone:206-257-0466
Practice Address - Fax:206-257-0466
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044369174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist