Provider Demographics
NPI:1023364106
Name:MOEN, KATRINA EILEEN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:EILEEN
Last Name:MOEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:EILEEN
Other - Last Name:WALZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:700 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1913
Mailing Address - Country:US
Mailing Address - Phone:360-397-3352
Mailing Address - Fax:360-604-1771
Practice Address - Street 1:291 C ST UNIT 110
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1644
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60301097363LF0000X
OR201250106NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily