Provider Demographics
NPI:1700050317
Name:BASSETT, KATRINA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:BASSETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1793 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2541
Mailing Address - Country:US
Mailing Address - Phone:503-362-8385
Mailing Address - Fax:503-362-8435
Practice Address - Street 1:15906 MILL CREEK BLVD
Practice Address - Street 2:#105
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1797
Practice Address - Country:US
Practice Address - Phone:425-385-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60217371207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology