Healthcare Provider Details

I. General information

NPI: 1972223733
Provider Name (Legal Business Name): KATHERINE DODGE MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4686 POINTES DR
MUKILTEO WA
98275-6038
US

IV. Provider business mailing address

1301 1ST AVE APT 2507
SEATTLE WA
98101-2158
US

V. Phone/Fax

Practice location:
  • Phone: 425-405-8089
  • Fax:
Mailing address:
  • Phone: 714-326-2971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61362728
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60925290
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: