Provider Demographics
NPI:1487654257
Name:AMUNDSON, CATHERINE W (ARNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:W
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:W
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:747 BROADWAY
Mailing Address - Street 2:SWEDISH HOME EXPRESS CARE DEPT.
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4379
Mailing Address - Country:US
Mailing Address - Phone:855-360-5472
Mailing Address - Fax:100-000-0000
Practice Address - Street 1:16315 NE 87TH ST
Practice Address - Street 2:STE B6
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3537
Practice Address - Country:US
Practice Address - Phone:425-882-1697
Practice Address - Fax:425-885-4179
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201709500363L00000X
MT132563363L00000X
WAAP30005002363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9626193Medicaid
WAP59379Medicare UPIN
WA9626193Medicaid