Provider Demographics
NPI:1720709108
Name:KREUTZ, KIRSTEN PEGGY
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:PEGGY
Last Name:KREUTZ
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 1:151 GOLDEN GATE AVE
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-7411
Mailing Address - Country:US
Mailing Address - Phone:406-750-8728
Mailing Address - Fax:
Practice Address - Street 1:1705 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0009
Practice Address - Country:US
Practice Address - Phone:206-616-9795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program