Healthcare Provider Details

I. General information

NPI: 1265485494
Provider Name (Legal Business Name): KATHLEEN MARY MCDONALD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20200 54TH AVE W
LYNNWOOD WA
98036-6318
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-6400
  • Fax: 425-672-6518
Mailing address:
  • Phone: 509-241-7349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberAP30003465
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP30003465
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: