Provider Demographics
NPI:1346043619
Name:BOTSET, KARISSA (LPN)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:BOTSET
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 69TH AVE W # E107
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5856
Mailing Address - Country:US
Mailing Address - Phone:813-480-6498
Mailing Address - Fax:
Practice Address - Street 1:9115 154TH AVENUE CT NW
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-9850
Practice Address - Country:US
Practice Address - Phone:253-649-5080
Practice Address - Fax:360-252-7016
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALP101070164W00000X
WALP61274753164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse