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General NPI Number Information
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NPI Number | 1104695485
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Entity Type | Individual
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Provider Name | KATTY RAISOR ARNP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 18313 PAULSON ST SW STE A
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City | ROCHESTER
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State | WA
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Zip | 98579-9262
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Country | US
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Telephone | 360-827-8400
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Fax | 360-273-7301
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Provider Business Mailing Address
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Address Line | PO BOX 3360
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City | PORTLAND
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State | OR
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Zip | 97208-3360
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61511127
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License Number State | WA
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