Provider Demographics
NPI:1528435229
Name:KINTNER, ELIZABETH LYN
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LYN
Last Name:KINTNER
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 1:243 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-9716
Mailing Address - Country:US
Mailing Address - Phone:509-910-3945
Mailing Address - Fax:
Practice Address - Street 1:5808 SUMMITVIEW AVE STE D
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3095
Practice Address - Country:US
Practice Address - Phone:509-910-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60487460172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker