Provider Demographics
NPI:1699008680
Name:KATHRYN S. DEANE ARNP, PLLC
Entity Type:Organization
Organization Name:KATHRYN S. DEANE ARNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:DEANE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-550-1819
Mailing Address - Street 1:1715 114TH AVE SE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6945
Mailing Address - Country:US
Mailing Address - Phone:206-550-1819
Mailing Address - Fax:206-922-5526
Practice Address - Street 1:1715 114TH AVE SE
Practice Address - Street 2:SUITE 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6945
Practice Address - Country:US
Practice Address - Phone:206-550-1819
Practice Address - Fax:206-922-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006919363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty