Provider Demographics
NPI:1194056408
Name:AVERY, KRISTINE ATWOOD (RN, BSN, LCCE, FACCE)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:ATWOOD
Last Name:AVERY
Suffix:
Gender:F
Credentials:RN, BSN, LCCE, FACCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 SORREL AVE NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-4027
Mailing Address - Country:US
Mailing Address - Phone:206-245-6997
Mailing Address - Fax:206-780-0501
Practice Address - Street 1:4502 SORREL AVE NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-4027
Practice Address - Country:US
Practice Address - Phone:206-245-6997
Practice Address - Fax:206-780-0501
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 00158069174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator