Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP60605385 | WA |
NPI | 1013388016 |
---|---|
Provider Name | Katelin Petrin |
First Address | Olympia, WA 98506-5175 |
Second Address | Olympia, WA 98506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2015 |
Last Update Date | 15/08/2019 |