Active NPI
Monrudee Koutouvidis, ARNP
- Nurse Practitioner
- Tacoma, WA
National Provider Identifier
1033201199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- AP30007448
- Practice address
- 1708 South Yakima Ave
Ste 110
Tacoma, WA 98405 - Phone
- (253) 627-9151
- Fax
- (253) 591-8892
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN00123567 | WA | |
| Nurse Practitioner | 363L00000X | AP30007448 | WA | Primary |
Addresses
Primary practice location
1708 South Yakima Ave
Ste 110
Tacoma, WA 98405
Mailing address
1708 South Yakima Ave
Ste 110
Tacoma, WA 98405
Phone (253) 627-9151
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0212477 | Other | WA | STATE L&I |
| 9650060 | Medicaid | WA | |
| P00354457 | Other | WA | RAILROAD |
| 8942875 | Other | WA | STATE CRIME VICTIMS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289347200000",
"number": "1033201199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1708 SOUTH YAKIMA AVE",
"address_2": "STE 110",
"city": "TACOMA",
"state": "WA",
"postal_code": "98405",
"telephone_number": "253-627-9151",
"fax_number": "253-591-8892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1708 SOUTH YAKIMA AVE",
"address_2": "STE 110",
"city": "TACOMA",
"state": "WA",
"postal_code": "98405",
"telephone_number": "253-627-9151",
"fax_number": "253-591-8892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOUTOUVIDIS",
"first_name": "MONRUDEE",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2010-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN00123567",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WA",
"license": "AP30007448",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0212477",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9650060",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "P00354457",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE CRIME VICTIMS",
"identifier": "8942875",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.