Basic Information
| Provider Information | |||||||||
| NPI: | 1134710726 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARMBRUSTER | ||||||||
| FirstName: | KAITLYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 268 BUSH ST STE 3039 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941043503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883623970 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12180 PARK AVE S | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984470001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513066412 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2021 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | CB61125641 | WA | Y |
ID Information
| ID | Type | State | Issuer | Description | RBT-20-146236 | 01 | RBT | OTHER |