Provider Demographics
NPI:1881012813
Name:BEACH, KATHLEEN INGRID (RN, CST)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:INGRID
Last Name:BEACH
Suffix:
Gender:F
Credentials:RN, CST
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:INGRID
Other - Last Name:MEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1204 N VERCLER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1020
Practice Address - Country:US
Practice Address - Phone:509-228-1000
Practice Address - Fax:509-252-9300
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00114383163WX0200X
WAST60145038246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist