Healthcare Provider Details

I. General information

NPI: 1659843456
Provider Name (Legal Business Name): MARY KATHRYN EDWARDS MS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE B2-AN
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

101 60TH PL SE
EVERETT WA
98203-3471
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-6980
  • Fax:
Mailing address:
  • Phone: 202-597-4693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60929531
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: