Provider Demographics
NPI:1821036898
Name:MATTESON, KATHLEEN (ND, ARNP)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:MATTESON
Suffix:
Gender:F
Credentials:ND, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19031 33RD AVE W
Mailing Address - Street 2:SUITE301
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4731
Mailing Address - Country:US
Mailing Address - Phone:425-778-5673
Mailing Address - Fax:425-774-2421
Practice Address - Street 1:19031 33RD AVE W
Practice Address - Street 2:SUITE301
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4731
Practice Address - Country:US
Practice Address - Phone:425-778-5673
Practice Address - Fax:425-774-2421
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000905175F00000X
WAAP30000540363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered175F00000XOther Service ProvidersNaturopath
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner