Provider Demographics
NPI:1700557477
Name:DONNERSTAG, CATHERINE WANJIRU
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:WANJIRU
Last Name:DONNERSTAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 LAKE WASHINGTON BLVD NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-5035
Mailing Address - Country:US
Mailing Address - Phone:443-600-8467
Mailing Address - Fax:
Practice Address - Street 1:1015 DEBBIE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3339
Practice Address - Country:US
Practice Address - Phone:443-600-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61272824363LP0808X
MDR208729364SP0812X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Community
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty