Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD00044689 | WA |
N | 207PE0004X | Emergency Medical Services | MD00044689 | WA |
NPI | 1184676116 |
---|---|
Provider Name | Kristofor D Norland |
First Address | Snohomish, WA 98290-7220 |
Second Address | Everett, WA 98201-1665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 29/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8426066 | (05) | WA |
I39445 | (02) | WA |