Provider Demographics
NPI:1750523361
Name:EGGLESTON, KRISTIN (LM, CPM)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1542
Mailing Address - Country:US
Mailing Address - Phone:509-780-3330
Mailing Address - Fax:866-359-8801
Practice Address - Street 1:2017 BENSON AVE
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1550
Practice Address - Country:US
Practice Address - Phone:509-780-3330
Practice Address - Fax:866-359-8801
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60026914176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife