Healthcare Provider Details

I. General information

NPI: 1790337558
Provider Name (Legal Business Name): KATHARINE CONLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 CAPITAL MALL DR SW
OLYMPIA WA
98502-8654
US

IV. Provider business mailing address

3841 MARI LN SE # 98513
OLYMPIA WA
98513-9315
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-5858
  • Fax:
Mailing address:
  • Phone: 978-618-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60954764
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: