Provider Demographics
NPI:1114111390
Name:MAGONIGLE, KATHLEEN JANINE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:JANINE
Last Name:MAGONIGLE
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 1:1901 S. UNION AVE.
Mailing Address - Street 2:SUITE A-244
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-459-6500
Mailing Address - Fax:253-459-6501
Practice Address - Street 1:7824 WILDA LN NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-9356
Practice Address - Country:US
Practice Address - Phone:360-413-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily