Healthcare Provider Details

I. General information

NPI: 1396131975
Provider Name (Legal Business Name): CAROLINE ALEXANDRA HARSTROEM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 NASSAU ST STE A
EVERETT WA
98201-4140
US

IV. Provider business mailing address

801 SW 16TH ST STE 121
RENTON WA
98057-2628
US

V. Phone/Fax

Practice location:
  • Phone: 206-538-6300
  • Fax: 206-538-6301
Mailing address:
  • Phone: 206-538-6300
  • Fax: 206-538-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberFE.60964666
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD61097991
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD61097991
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD61097991
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: