Healthcare Provider Details

I. General information

NPI: 1568649564
Provider Name (Legal Business Name): KATHERINE G. WILKENS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATY G. WILKENS RD

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BROADWAY
SEATTLE WA
98122-4310
US

IV. Provider business mailing address

700 BROADWAY
SEATTLE WA
98122-4310
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-2771
  • Fax: 206-292-3014
Mailing address:
  • Phone: 206-292-2771
  • Fax: 206-292-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberD1001959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: