Provider Demographics
NPI:1295074383
Name:MODICA, KATHERINE VICTORIA (ND)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:VICTORIA
Last Name:MODICA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17413 WOODCREST DR NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5420
Mailing Address - Country:US
Mailing Address - Phone:206-384-9039
Mailing Address - Fax:
Practice Address - Street 1:17413 WOODCREST DR NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5420
Practice Address - Country:US
Practice Address - Phone:206-384-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60336456175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath