Provider Demographics
NPI:1023736097
Name:KRISTIE MATTERN LLC
Entity type:Organization
Organization Name:KRISTIE MATTERN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTERN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:253-973-6135
Mailing Address - Street 1:7902 27TH ST W STE 7A
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-3431
Mailing Address - Country:US
Mailing Address - Phone:253-500-4059
Mailing Address - Fax:
Practice Address - Street 1:7902 27TH ST W STE 7A
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-3431
Practice Address - Country:US
Practice Address - Phone:253-500-4059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023392529OtherNPI