Provider Demographics
NPI:1699859660
Name:BLOISE, KATHERINE RM (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RM
Last Name:BLOISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:R
Other - Last Name:MCNALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3768
Mailing Address - Country:US
Mailing Address - Phone:360-895-5000
Mailing Address - Fax:360-895-5034
Practice Address - Street 1:1400 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3711
Practice Address - Country:US
Practice Address - Phone:360-895-5000
Practice Address - Fax:360-895-5034
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61223493207Q00000X
CAG69357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G693570Medicaid
CA00G693570Medicaid
F41232Medicare UPIN