Provider Demographics
NPI:1487932513
Name:MAGNUSON, KATHERINE M (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3340 PROVIDENCE DRIVE
Mailing Address - Street 2:SUITE 452
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4628
Mailing Address - Country:US
Mailing Address - Phone:907-562-2120
Mailing Address - Fax:907-562-6527
Practice Address - Street 1:3340 PROVIDENCE DRIVE
Practice Address - Street 2:SUITE 452
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4628
Practice Address - Country:US
Practice Address - Phone:907-562-2120
Practice Address - Fax:907-562-6527
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI60322-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics