Provider Demographics
NPI:1396983433
Name:WILSON, KIT (RN)
Entity type:Individual
Prefix:MR
First Name:KIT
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:GEOFFREY
Other - Middle Name:KIT
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4019B 166TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8443
Mailing Address - Country:US
Mailing Address - Phone:425-239-2099
Mailing Address - Fax:
Practice Address - Street 1:3000 NE 4TH ST
Practice Address - Street 2:RENTON TECHNICAL COLLEGE
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4195
Practice Address - Country:US
Practice Address - Phone:425-235-2352
Practice Address - Fax:425-235-2435
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00125443163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency