Provider Demographics
NPI:1740631704
Name:EINANDER, KATRINA ALINE (LM)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ALINE
Last Name:EINANDER
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:KAIDE
Other - Middle Name:ALINE
Other - Last Name:EINANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-0041
Mailing Address - Country:US
Mailing Address - Phone:206-778-2347
Mailing Address - Fax:844-675-9487
Practice Address - Street 1:2619 CHERRY ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-2909
Practice Address - Country:US
Practice Address - Phone:206-778-2347
Practice Address - Fax:844-675-9487
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60650176176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2063863Medicaid