Provider Demographics
NPI:1154596161
Name:DUDOWARD, KRISTA GILLIAN (LMP)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:GILLIAN
Last Name:DUDOWARD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 ORLEANS STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-739-0399
Mailing Address - Fax:
Practice Address - Street 1:2717 ORLEANS ST
Practice Address - Street 2:SUITE A
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-4658
Practice Address - Country:US
Practice Address - Phone:360-739-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016124225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist