Provider Demographics
NPI:1982817060
Name:REUDINK, MIKHAILA BARG (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MIKHAILA
Middle Name:BARG
Last Name:REUDINK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:MIKHAILA
Other - Middle Name:
Other - Last Name:BARG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6542 17TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6843
Mailing Address - Country:US
Mailing Address - Phone:206-861-3442
Mailing Address - Fax:206-328-7522
Practice Address - Street 1:2001 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2959
Practice Address - Country:US
Practice Address - Phone:206-328-7722
Practice Address - Fax:206-328-7522
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 17131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily