Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | NT00001645 | WA |
NPI | 1013187434 |
---|---|
Provider Name | Jannine Krause |
First Address | Seattle, WA 98121-1667 |
Second Address | Seattle, WA 98121-2704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2008 |
Last Update Date | 30/12/2013 |