Healthcare Provider Details

I. General information

NPI: 1295755783
Provider Name (Legal Business Name): KATRINA MAE DIPPLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE # OC9.850
SEATTLE WA
98105
US

IV. Provider business mailing address

4800 SAND POINT WAY NE # OC9.850
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2056
  • Fax: 206-987-2495
Mailing address:
  • Phone: 206-987-2056
  • Fax: 206-987-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License NumberA61420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: