Provider Demographics
NPI:1487318044
Name:DYKSTRA, KAITLIN E (RN)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:E
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:WA
Mailing Address - Zip Code:98591-1022
Mailing Address - Country:US
Mailing Address - Phone:360-508-3676
Mailing Address - Fax:
Practice Address - Street 1:310 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3809
Practice Address - Country:US
Practice Address - Phone:360-807-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00160640163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool