Basic Information
| Provider Information | |||||||||
| NPI: | 1043819907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRABBENDAM | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | SEAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4804 215TH LN SW UNIT 32 | ||||||||
| Address2: | |||||||||
| City: | MOUNTLAKE TERRACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980433661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602988960 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7315 212TH ST SW STE 207 | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257759474 | ||||||||
| FaxNumber: | 4256703554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP61101386 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.