Provider Demographics
NPI:1205959459
Name:KITTLE, ESTHER LAURA (MD)
Entity type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:LAURA
Last Name:KITTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ESTHER
Other - Middle Name:LAURA
Other - Last Name:KITTLE/NORDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0260
Mailing Address - Country:US
Mailing Address - Phone:360-748-0211
Mailing Address - Fax:360-748-8732
Practice Address - Street 1:1299 BISHOP RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-8758
Practice Address - Country:US
Practice Address - Phone:360-748-0211
Practice Address - Fax:360-748-8732
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G49704Medicare UPIN
WAG49704Medicare UPIN