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General NPI Number Information
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NPI Number | 1619208360
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Entity Type | Individual
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Provider Name | KATHRINE ANN BRODERICK ND
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Gender | Female
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 4459 FREMONT AVE N
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City | SEATTLE
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State | WA
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Zip | 98103-7293
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Country | US
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Telephone | 206-419-8516
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Fax | 206-315-5398
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Provider Business Mailing Address
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Address Line | 8336 NE 110TH PL
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City | KIRKLAND
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State | WA
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Zip | 98034-3545
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Country | US
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Telephone | 206-419-8516
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Fax | 206-315-5398
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NT60116885
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License Number State | WA
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