Provider Demographics
NPI:1356382063
Name:NERAAS, KATHRYN ANN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:NERAAS
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 1:2611 NE 125TH ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4373
Mailing Address - Country:US
Mailing Address - Phone:206-364-1195
Mailing Address - Fax:206-364-0893
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:SUITE 245
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-364-1195
Practice Address - Fax:206-364-0893
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000299932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB15444Medicare ID - Type Unspecified
WAF89367Medicare UPIN