Healthcare Provider Details

I. General information

NPI: 1568497048
Provider Name (Legal Business Name): CATHERINE J. CORNELL A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE MAIL STOP W8851
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

6516 NE 198TH ST
KENMORE WA
98028-8662
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-3562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP30000519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: