Provider Demographics
NPI:1114038437
Name:MORENO, KATHERINE IONE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:IONE
Last Name:MORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-366-2983
Mailing Address - Fax:
Practice Address - Street 1:3216 NORTON AVE
Practice Address - Street 2:STE 202
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4290
Practice Address - Country:US
Practice Address - Phone:425-297-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008607208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8926692Medicare UPIN