Provider Demographics
NPI:1336797216
Name:DIPIETRO, KATHERINE MYCHAL (CNM)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MYCHAL
Last Name:DIPIETRO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MYCHAL
Other - Last Name:BRANAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 NE 139TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2519
Mailing Address - Country:US
Mailing Address - Phone:360-433-0022
Mailing Address - Fax:360-433-6159
Practice Address - Street 1:900 NE 139TH ST STE 206
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2519
Practice Address - Country:US
Practice Address - Phone:360-433-0022
Practice Address - Fax:360-433-6159
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202213862NP-PP367A00000X
WAAP60997783176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife