Provider Demographics
NPI:1104204130
Name:KATHI GUNN ARNP FNP-BC PBP, PLLC
Entity Type:Organization
Organization Name:KATHI GUNN ARNP FNP-BC PBP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ARNP
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-808-2859
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:CARLSBORG
Mailing Address - State:WA
Mailing Address - Zip Code:98324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:519 EUREKA WAY STE 1
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-808-7533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002430261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center