Healthcare Provider Details

I. General information

NPI: 1972013217
Provider Name (Legal Business Name): KATHERINE ROSE MILLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2017
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 MERIDIAN AVE N
SEATTLE WA
98133-9509
US

IV. Provider business mailing address

1200 12TH AVE S STE 901
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-296-4990
  • Fax: 206-205-5142
Mailing address:
  • Phone: 206-548-3114
  • Fax: 206-762-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60917243
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: