Provider Demographics
NPI:1649601667
Name:KOLETO, KATRINA (LMP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:KOLETO
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 1:10002 AURORA AVE N
Mailing Address - Street 2:STE 36 PMB 1128
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9347
Mailing Address - Country:US
Mailing Address - Phone:206-920-6052
Mailing Address - Fax:
Practice Address - Street 1:6826 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5258
Practice Address - Country:US
Practice Address - Phone:206-920-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-01
Last Update Date:2013-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60415582174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist