Healthcare Provider Details

I. General information

NPI: 1407347677
Provider Name (Legal Business Name): KATHERINE ELIZABETH THORSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 NW MYHRE RD STE 1220
SILVERDALE WA
98383-8676
US

IV. Provider business mailing address

1780 NW MYHRE RD STE 1220
SILVERDALE WA
98383-8676
US

V. Phone/Fax

Practice location:
  • Phone: 360-698-4500
  • Fax: 360-698-6960
Mailing address:
  • Phone: 360-698-4500
  • Fax: 360-698-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD61667218
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD61667218
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: