Provider Demographics
NPI:1982761110
Name:YOUNG CRISSMAN, AUDREY (MD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:YOUNG CRISSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3216 NE 45TH PL STE 301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4028
Mailing Address - Country:US
Mailing Address - Phone:206-339-3360
Mailing Address - Fax:206-212-1100
Practice Address - Street 1:3216 NE 45TH PL STE 301
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4028
Practice Address - Country:US
Practice Address - Phone:206-339-3360
Practice Address - Fax:206-212-1100
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
185190OtherINTERNAL ID-MOTOR VEHICLE ID
WA110239573OtherRAILROAD MEDICARE
WA8319576Medicaid
185190OtherINTERNAL ID-MOTOR VEHICLE ID
AB29856Medicare ID - Type Unspecified
WA8805755Medicare PIN
H64497Medicare UPIN