Provider Demographics
NPI:1326575432
Name:CLASSEN, KATHY JO
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:JO
Last Name:CLASSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 AUBURN WAY N STE AF
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4100
Mailing Address - Country:US
Mailing Address - Phone:206-477-0588
Mailing Address - Fax:
Practice Address - Street 1:901 AUBURN WAY N STE A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4100
Practice Address - Country:US
Practice Address - Phone:206-477-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60212854163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse