Healthcare Provider Details

I. General information

NPI: 1770948887
Provider Name (Legal Business Name): CATHLEEN SANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N 32ND ST UNIT 4
RENTON WA
98056-2565
US

IV. Provider business mailing address

740 N 32ND ST UNIT 4
RENTON WA
98056
US

V. Phone/Fax

Practice location:
  • Phone: 206-356-6690
  • Fax:
Mailing address:
  • Phone: 206-356-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60380015
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: