Provider Demographics
NPI:1518417617
Name:GALLIANO, KATINA A (PA-C)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:A
Last Name:GALLIANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATINA
Other - Middle Name:A
Other - Last Name:VELLOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11913 NE 195TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3147
Mailing Address - Country:US
Mailing Address - Phone:425-489-3100
Mailing Address - Fax:425-489-3183
Practice Address - Street 1:11913 NE 195TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3147
Practice Address - Country:US
Practice Address - Phone:425-489-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60679189363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical