Healthcare Provider Details

I. General information

NPI: 1205409711
Provider Name (Legal Business Name): KATIE LORRAINE PAULEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KATIE LORRAINE SINNOTT

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CAPITAL MALL DR SW STE A
OLYMPIA WA
98502-8654
US

IV. Provider business mailing address

PO BOX 368
OLYMPIA WA
98507-0368
US

V. Phone/Fax

Practice location:
  • Phone: 360-709-6230
  • Fax:
Mailing address:
  • Phone: 360-709-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61183792
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: