Provider Demographics
NPI:1023029394
Name:DEANE, KATHRYN S (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:DEANE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5817
Mailing Address - Country:US
Mailing Address - Phone:206-550-1819
Mailing Address - Fax:206-420-0363
Practice Address - Street 1:311 11TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5817
Practice Address - Country:US
Practice Address - Phone:206-550-1819
Practice Address - Fax:206-430-0363
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006919363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00235425OtherRAILROAD
WA0197109OtherL & I
WA8905865OtherCRIME VICTIMS
WA9645003Medicaid
Q47275Medicare UPIN
WA9645003Medicaid