Healthcare Provider Details

I. General information

NPI: 1245112416
Provider Name (Legal Business Name): KATHERINE MOISE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 108TH AVE NE STE 204
BELLEVUE WA
98004-7613
US

IV. Provider business mailing address

707 TERRY AVE APT 1116
SEATTLE WA
98104-2141
US

V. Phone/Fax

Practice location:
  • Phone: 425-242-1713
  • Fax:
Mailing address:
  • Phone: 276-312-5891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number107081
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: