Healthcare Provider Details

I. General information

NPI: 1275036006
Provider Name (Legal Business Name): KATHERINE MARIE SPENCER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE # OC.7830
SEATTLE WA
98105
US

IV. Provider business mailing address

4800 SAND POINT WAY NE # OC.7830
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2525
  • Fax:
Mailing address:
  • Phone: 206-987-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.MD.61150124
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: