Provider Demographics
NPI:1982006839
Name:CHRISTOFERSEN, KATHRYN (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CHRISTOFERSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22905 125TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3676
Mailing Address - Country:US
Mailing Address - Phone:206-790-1991
Mailing Address - Fax:
Practice Address - Street 1:200 ANDOVER PARK E STE 8
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2938
Practice Address - Country:US
Practice Address - Phone:206-575-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL60563868207ZP0102X
390200000X
WAOP60931602207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program