Healthcare Provider Details

I. General information

NPI: 1174854764
Provider Name (Legal Business Name): KATHRYN MARY BURRELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 PROVIDENCE LN NE
OLYMPIA WA
98506-6927
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-5369
  • Fax:
Mailing address:
  • Phone: 360-486-6508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30006040
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: