Provider Demographics
NPI:1609890755
Name:MILLMAN, KATHERINE MACOMBER (LMP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MACOMBER
Last Name:MILLMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 29TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6130
Mailing Address - Country:US
Mailing Address - Phone:360-385-5982
Mailing Address - Fax:
Practice Address - Street 1:818 CORONA ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-4920
Practice Address - Country:US
Practice Address - Phone:360-385-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005496171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1523847OtherCOMMUNITY HEALTH PLAN OF WASHINGTON