Provider Demographics
NPI:1619527595
Name:CARPENTER, KATHERINE DOREEN
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DOREEN
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:DOREEN
Other - Last Name:HAWKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1321 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1665
Mailing Address - Country:US
Mailing Address - Phone:425-261-3559
Mailing Address - Fax:425-261-3560
Practice Address - Street 1:1321 COLBY AVE
Practice Address - Street 2:C-WING FIRST FLOOR
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-261-3559
Practice Address - Fax:425-261-3560
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00021175183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013906528OtherTHIRD PARTY INSURANCES