Provider Demographics
NPI:1366277535
Name:RHODES, KATIE MARIE (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:MARIE
Last Name:RHODES
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23726 SE ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-5029
Mailing Address - Country:US
Mailing Address - Phone:360-536-6412
Mailing Address - Fax:
Practice Address - Street 1:23726 SE ADAMS ST
Practice Address - Street 2:
Practice Address - City:BLACK DIAMOND
Practice Address - State:WA
Practice Address - Zip Code:98010-5029
Practice Address - Country:US
Practice Address - Phone:360-536-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL-165435163WL0100X
WARN60961074163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse