Provider Demographics
NPI:1205346806
Name:REVERE, KREED
Entity type:Individual
Prefix:
First Name:KREED
Middle Name:
Last Name:REVERE
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 1:266 SENECA AVE NW
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5151
Mailing Address - Country:US
Mailing Address - Phone:206-686-8001
Mailing Address - Fax:888-869-4487
Practice Address - Street 1:266 SENECA AVE NW
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5151
Practice Address - Country:US
Practice Address - Phone:206-686-8001
Practice Address - Fax:888-869-4487
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula