Provider Demographics
NPI:1083717904
Name:TANAKA, KATSUKO (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KATSUKO
Middle Name:
Last Name:TANAKA
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 1:4700 42ND AVE SW
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4591
Mailing Address - Country:US
Mailing Address - Phone:206-933-0699
Mailing Address - Fax:206-932-6045
Practice Address - Street 1:4700 42ND AVE SW
Practice Address - Street 2:SUITE 430
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4591
Practice Address - Country:US
Practice Address - Phone:206-933-0699
Practice Address - Fax:206-932-6045
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00086690163WP0809X
WAAP30002001364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult