Healthcare Provider Details

I. General information

NPI: 1316454234
Provider Name (Legal Business Name): CATHERINE ANN MOONAN RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2017
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 4TH AVE FL 4
SEATTLE WA
98121-2308
US

IV. Provider business mailing address

43 ROSE HILL DR
CRANSTON RI
02920-3022
US

V. Phone/Fax

Practice location:
  • Phone: 206-477-8214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN01740
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number147769
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60972605
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN60857595
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: