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Organization
PRUDENT MEDICAL PROVIDERS NW
Active
Organization
PRUDENT MEDICAL PROVIDERS NW
Active
Other names
N/A
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTYN DICE (CONTRACTING MANAGER)
(208) 717-3944
Entity
Organization
Contact information
Practice address
1045 S 320TH ST STE 7, FEDERAL WAY, WA 98003-5179
(206) 212-6554
Mailing address
4523 42ND ST NE, TACOMA, WA 98422-2424
(206) 245-4902
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
01/15/2021
Last updated
07/13/2023
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