Provider Demographics
NPI:1275520066
Name:HARTJOY, CATHERINE A (PAC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:HARTJOY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 S UNION AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1947
Mailing Address - Country:US
Mailing Address - Phone:253-752-6965
Mailing Address - Fax:253-759-6056
Practice Address - Street 1:1802 S UNION AVE
Practice Address - Street 2:STE 200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1947
Practice Address - Country:US
Practice Address - Phone:253-752-6965
Practice Address - Fax:253-759-6056
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOA10000230363A00000X
WAPA60895931363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6450STOtherREGENCE BCBS
WA0200260OtherLABOR & INDUSTRIES
Q50464Medicare UPIN
WA6450STOtherREGENCE BCBS