Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP60796719 | WA |
NPI | 1003331414 |
---|---|
Provider Name | Kathryn Laurel Anderson |
First Address | Maple Valley, WA 98038-5294 |
Second Address | Maple Valley, WA 98038-5294 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2017 |
Last Update Date | 27/03/2018 |