Provider Demographics
NPI:1245464551
Name:CARRERA, KATHERINE ELIZABETH (NNP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:CARRERA
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:OTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1265 ESSEX ST
Mailing Address - Street 2:UNIT 7
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3323
Mailing Address - Country:US
Mailing Address - Phone:619-203-9054
Mailing Address - Fax:
Practice Address - Street 1:3340 PROVIDENCE DR
Practice Address - Street 2:SUITE 366
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4627
Practice Address - Country:US
Practice Address - Phone:907-563-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK345363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care